JCO Research Round Up
March 28, 2011
A new study on the use of PSA (prostate-specific antigen) testing to screen for prostate cancer found that elderly men are being screened much more frequently than men in their early fifties, even though younger men are more likely to benefit from early diagnosis and treatment. Researchers showed that men in their seventies underwent PSA screening for prostate cancer at nearly twice the rate of men in their early fifties. Men 85 and older were screened just as often.
Because prostate cancer tends to be slow-growing, data show that many men - particularly those in their seventies and older - will die of other causes before prostate cancer becomes a problem that requires medical attention. The findings underscore an ongoing concern that overuse of PSA screening and treatment decisions based on PSA results may lead to unnecessary treatment of many older men for whom there is little benefit from treating the cancer.
While large declines in prostate cancer metastases and death rates in the last 20 years coincide with widespread use of PSA-based screening, questions remain about its use, including what age to begin routine screening, who should be screened and when screening should stop.
Major organizations such as the American Cancer Society now encourage men who expect to live at least 10 years to talk with their doctor about the risks and benefits of screening, starting at age 50 for men with an average risk or at age 45 for men with a higher risk.
To gauge PSA screening in the general population, researchers examined results from federal government-sponsored health surveys of randomly selected households, including more than 2,600 men ages 70 and older and nearly 12,000 controls between the ages of 40 and 69. The researchers found that 24 percent of men ages 50 to 54 were screened, with the rate increasing with age to 45 percent of men ages 70 to 74. Rates then declined with age, with slightly less than 25 percent of men 85 or older being screened.
The authors note that such screening rates may reflect the frequency of doctor's visits, since older men tend to have more health problems that require seeing a doctor, and this may in turn result in more frequent PSA testing than younger men who usually go to the doctor less often. They suggest that physicians be more selective in recommending PSA testing, taking into account patient age and health.
What This Means for Patients
This study shows that many elderly men are undergoing unnecessary prostate cancer screenings, which could lead to the diagnosis and treatment of tumors that would never be life-threatening. Conversely, only a relatively low percentage of men in their fifties, who are more likely to benefit from early prostate cancer diagnosis and related treatment, are actually screened. Men are encouraged to talk with their doctor about their individual risk for prostate cancer, and about the risks and benefits of prostate cancer screening.