A study of almost 600,000 men aged 70 and older reveals that 56 percent had a routine prostate-specific antigen (PSA) screening, a blood test for prostate cancer, even though no treatment guidelines recommend PSA screening for men of that age.
Screening rates declined with age, but overall health had little or no impact on whether a PSA test was performed.
In fact, says lead author Louise C. Walter, MD, a staff physician at the San Francisco VA Medical Center, health status had so little bearing on the decision to screen that 36 percent of men age 85 and older who were in poor health and at high risk of dying within a year were given the test.
"Not a single professional organization, physicians' group, or prostate cancer advocacy group advocates PSA screening for frail, elderly men, and yet we are doing it," says Walter, who is also an assistant professor of medicine at the University of California, San Francisco.
The study appears in the November 15, 2006 issue of the Journal of the American Medical Association.
In general, performing the PSA test on men 70 and older is a poor idea for a number of reasons, Walter says. "First, as you grow older, there's good evidence that PSA becomes less accurate. Second, not all prostate cancers are alike." The PSA test is best at detecting slow-growing cancers that will have a health impact 10 to 15 years after they are found, Walter explains, while it tends to miss aggressive, fast-growing cancers. "Third, it's been well-documented that older men, particularly those with chronic or severe illnesses, have more complications from all types of prostate cancer treatment than younger men." Finally, says Walter, even if no treatment is performed, simply the knowledge of an elevated PSA causes anxiety and thus has a negative impact on quality of life.
"This is why no guideline recommends PSA screening for men who, taking health status as well as age into account, have a lif
Contact: Steve Tokar
University of California - San Francisco