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Too Many Elderly Men Tested for Prostate Cancer?

Nearly 1.5 million American men over age 75 get PSA tests each year to screen for prostate cancer, according to a study published in the Journal of the National Cancer Institute (Vol. 95, No. 23:1792-1797). Unfortunately, there's little proof that the screenings do them any good.

Because prostate cancer typically grows so slowly, elderly men are more likely to die from other causes (heart disease, for instance) before prostate cancer can even cause symptoms, much less kill them. Furthermore, if prostate cancer is detected in these men, the treatment for it can cause serious side effects like incontinence and impotence that can lower a man's quality of life without necessarily increasing his quantity of life.

For those reasons, wrote lead author Grace Lu-Yao, PhD, of the New Jersey Cancer Institute, "There has been general agreement that elderly men (i.e., those aged 75 years or older) should not be screened."

Some health organizations do not recommend PSA (or prostate-specific antigen) tests for men of any age. The American Cancer Society (ACS) recommends that screening be offered, after a discussion of the pros and cons, to men who have a life expectancy of at least 10 years.

"Not every 75-year-old man is the same," said Durado Brooks, MD, director of prostate and colorectal cancer for ACS. The decision to be screened needs to be based on each man's individual health, he explained.

Lu-Yao and her colleagues wanted to get a better idea of how many elderly men were getting screened, whether doctors were recommending the test, and whether the men were being told of the drawbacks and benefits before being tested.

Elderly men without prostate cancer were asked whether they had been given a blood test for PSA in the previous year. Elevated PSA levels could be a sign of prostate cancer, although other less worrisome conditions also can raise PSA; a biopsy is usually needed to make a firm diagnosis.

More than 32% of men over age 75 reported having had a PSA test in the previous 12 months. Of those, more than 88% said their doctor had first recommended the test.

"It is somewhat surprising that so many physicians would suggest screening (or be perceived as suggesting screening) in elderly men when the benefits have not even been established among younger men," the researchers wrote.

Screening men who are unlikely to benefit from the test results may not be the best use of health care dollars, they said. And elderly men who are diagnosed as having prostate cancer may experience substantial anxiety if they choose not to treat it immediately (a strategy known as "expectant therapy").

Factors that raise prostate cancer risk, such as race and family history of the disease, did not appear to influence the screening rates; neither did a man's overall health.

More than 66% of the elderly men who were screened reported having a discussion with their doctor about the advantages and disadvantages of the PSA test.

Although that number is still too low ? all men should have this discussion before choosing to be screened ? it's higher than previously believed, Brooks said. This study could prompt more men to ask their doctors about whether prostate cancer screening is right for them, he added.

The researchers say screening decisions need to be made by patients, doctors, and society working together. They urge the development of better strategies to increase understanding of the risks and benefits of PSA testing in elderly men.