A recent study highlights the overuse of prostate-specific antigen (PSA) testing among elderly men in the United States, raising concerns about unnecessary prostate cancer screenings. The research, based on surveys conducted in 2000 and 2005, found that nearly half of men in their seventies underwent PSA testing in the past year—almost double the rate of men in their early fifties. Even men aged 85 and older were screened at rates comparable to those in their fifties, who are more likely to benefit from early cancer detection.
Prostate cancer is often slow-growing, and many older men, particularly those in their seventies and beyond, are more likely to die from other causes before prostate cancer becomes a significant health issue. The study’s findings reinforce concerns about the overuse of PSA screening and treatment in older men, which may lead to unnecessary interventions and complications such as incontinence, impotence, and bowel dysfunction.
Scott Eggener, MD, senior author of the study and assistant professor of surgery at the University of Chicago, commented, “Our findings show a high rate of elderly and sometimes ill men being inappropriately screened for prostate cancer. We’re concerned these screenings could lead to unnecessary treatments that ultimately do more harm than good.”
The study also revealed that nearly three-quarters of men in their fifties were not screened in the past year, highlighting a gap in screening practices. Eggener emphasized the need for more in-depth discussions between doctors and patients about the benefits and risks of prostate cancer screening.
Over the last two decades, a decline in prostate cancer metastases and death rates has been linked to the widespread use of PSA screening. However, the optimal age for screening and when to stop has remained unclear. Recent studies have provided conflicting evidence on whether PSA testing reduces the risk of dying from prostate cancer. As a result, organizations like the American Cancer Society recommend that men begin discussing the risks and benefits of screening with their doctor starting at age 50 for those with average risk, or age 45 for those at higher risk.
The study analyzed data from the National Health Interview Survey, focusing on men aged 40 and older. In 2000, 23.7% of men had a PSA test within the past year, increasing to 26% in 2005. The screening rate was lowest among men aged 40 to 44 (7.5%), and increased with age, peaking at 45.5% for men aged 70 to 74. After that, screening rates declined, with 24.6% of men aged 85 and older reporting PSA testing.
Among men aged 70 and older, those with a higher estimated five-year life expectancy were more likely to be screened. For instance, 47.3% of men with a low chance of dying within five years were screened, compared to only 30.7% of those with the highest likelihood of dying in the same period.
Eggener suggested that the frequency of doctor visits among older men, who tend to have more health problems, might contribute to higher screening rates. He urged physicians to be more selective in recommending PSA tests for older men, especially those with limited life expectancy, and to focus on younger, healthier men who are more likely to benefit from early detection.
Dr. Nicholas Vogelzang, a prostate cancer specialist and ASCO Cancer Communications Committee member, added, “The underuse of PSA testing in younger men and the overtreatment of older men with slow-growing prostate cancer remain major concerns. This study reinforces the importance of considering a variety of factors, including age and co-existing health conditions, when making screening and treatment decisions.”
As the study underscores, discussions between patients and doctors about individual risk factors and the pros and cons of PSA screening are essential for informed decision-making.
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