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Men Over 75 Fail to Follow Screening Advice for PSA Testing (May 22, 2012)

Despite the recent conclusion of The United States Preventive Services Task Force, a national panel of medical experts, and similar 2008 recommendations, many older men are receiving prostate checks and diagnoses that aren't recommended. The panel says that men over the age of 75 shouldn't get the standard prostate cancer screening, including the PSA blood test and the PSA Free and Total test, since early diagnosis won't help them. While it may seem counter-intuitive not to check for cancer, excessive testing comes with some significant downsides, including extra psychological stress and unnecessary treatments.

Screening Statistics

Despite these recommendations, most men over the age of 75 still get checked for prostate cancer. In 2010, about 44 percent of men in this age group had a prostate-specific antigen, or PSA test. That's a rate that's almost identical to the screening rate in 2005. This lack of change over time indicates that doctors and patients may not be paying attention to the panel's recommendations. Researchers from the Medical Center at the University of Chicago checked survey information from thousands of men aged 40 and up. They compared data from 2010 with that collected five years earlier. The results suggested that doctors haven't changed their practices in terms of referring older patients for prostate screenings. Men over the age of 75 are actually more likely to receive screening than patients in their 50s, despite the fact that the younger patients receive more benefit. Men aged between 60 and 74 receive the most screening; over half of patients get their PSA levels checked.

Newer Screening Recommendations

The failure of physicians to adopt the screening guidelines issued four years ago doesn't provide a good outlook for the panel's newest recommendations, issued in 2011. These recommendations suggest that all men should avoid routine prostate screening, even if they are relatively young and could benefit from early cancer detection. The recommendations aren't yet official, since they're in draft form, but they suggest that PSA screening could have unpleasant side effects in the form of over-treatment and extra worry.

PSA Screening Controversy

According to doctors not involved in the study or the panel that made the recommendations, most medical professionals either strongly support routine PSA screening or believe it to be unnecessary and invasive. Those physicians who believe in regular screening tend to recommend it to all patients over the age where prostate cancer risk increases. Those who don't believe in the screening often don't offer it to any of their patients unless the test has been requested by the patient himself. Both of these practices ignore individual variation among patients and can produce undesirable results. Data from European studies clearly indicates that some men can benefit from PSA screening. This test often reduces the risk of death from prostate cancer. Many doctors overuse the screening, however, administering it to patients who won't benefit from cancer treatments. In fact, in some older men, treatment can cause a host of unpleasant side effects that make quality of life worse. Who Should Be Screened? Screening can definitely benefit some patients, but it's detrimental to others. Many studies checking the effectiveness of this test don't bother to distinguish between the two situations. The patients most likely to benefit from routine PSA screening are men who are relatively healthy and have a strong likelihood of living for another 10 years or more. Screening men who are suffering from severe illnesses or those who aren't likely to survive for a long period can provide a positive diagnosis that doesn't increase quality of life or chances of survival. Currently, about 20 percent of the men who receive screening for prostate-specific antigen state that their health is poor to fair. About 30 percent of patients who get a PSA test have a strong chance of dying within the next decade. These deaths are unlikely to come from prostate cancer. Instead, they're related to heart disease, high blood pressure, and other chronic diseases. Since tumors in older men tend to be slow growing and without symptoms, most of these patients are unlikely to survive long enough for their prostate cancer to affect their health significantly. Treatment, however, including surgery and radiation, carries a chance of sexual problems, urinary incontinence, and even death under anesthesia. 

Doctors and patients should consider the individual situation before requesting a PSA check. Health is a better indicator of screening benefits than age, with very healthy, vigorous patients benefiting more from the test than those in poor health. Panels often avoid this kind of recommendation because doctors prefer simple, clear-cut guidelines. While those guidelines are easier to understand, they don't provide the maximum benefit for patients. A nuanced approach to testing in which patients take the time and effort to inform themselves and request what's best for their health, offers better results and less risk than blanket recommendations.