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Elderly men receiving excessive prostate cancer screening, study suggests

Physicians are frequently recommending prostate-specific antigen (PSA) screening to men ages 75 and older, despite general agreement that routine prostate cancer screening of men in this age range has little benefit, according to a study in the December 3 issue of the Journal of the National Cancer Institute.

The decision not to screen elderly men is based on several factors, including the lack of evidence that treatment improves prostate cancer mortality in elderly men. However, with some studies suggesting that many elderly men are being screened, it is not clear whether screening is being initiated at the request of the patient or by the physician. In addition, there is little information about whether physicians are discussing the risks and benefits of screening with patients before testing.

Grace Lu-Yao, Ph.D., of HealthStat in Princeton, N.J., and the Cancer Institute of New Jersey, New Brunswick, Therese A. Stukel, Ph.D., of the Institute for Clinical Evaluative Sciences in Toronto, and Siu-Long Yao, M.D., of the Cancer Institute of New Jersey, reviewed information about screening in a nationally representative sample of 7,889 men who participated in the 2000 National Health Interview Survey.

Approximately 32.5% of men ages 75 or older reported that they had undergone a PSA screening test during the preceeding 12 months, which on the national level would represent approximately 1.47 million U.S. men. Among screened elderly men, 88.4% reported that their doctor first suggested screening and 66.5% reported having a discussion about the advantages and disadvantages of the test with their doctor before the screening was performed.

"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 authors write.

They acknowledge limitations with the survey, including errors in s
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Contact: Katherine Arnold
jncimedia@oupjournals.org
301-841-1287
Journal of the National Cancer Institute
2-Dec-2003


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