PSA Testing Rates Unchanged for Elderly Men Despite Task Force Guidelines
SAN FRANCISCO—PSA testing rates for men aged 75 years and older did not decline despite a 2008 U.S. Preventive Services Task Force (USPSTF) recommendation against PSA screening for men in this age group, according to study findings presented at the annual Genitourinary Cancers Symposium.
Using data from the 2005 and 2010 National Health Interview Survey, a cross-sectional household survey providing a representative sample of the U.S. population, investigators found that PSA tests were ordered for 40.6% of men aged 75 years and older in 2010 compared with 40.4% in 2005.
In addition, the study, led by Michael W. Drazer, a fourth-year medical student at the University of Chicago, found that PSA testing in 2010 was significantly more common in men aged 75 and older than in men aged 40 to 49 (9.2%) and 50-59 (26.2%).
“Despite the USPSTF recommendation against prostate cancer screening in men aged 75 or older, there was no decrease in PSA testing rates in these men,” the researchers concluded. “A significant proportion of elderly men continue to receive PSA screening despite a very low likelihood of benefit.”
Speculating as why PSA testing has not waned for men aged 75 and older, Drazer said that physicians may believe “the controversy hasn't really been resolved yet” regarding the value of PSA testing in elderly men. “They're more likely to err on the side of caution,” Drazer said. In addition, he observed that sometimes men want to continue with their screening past age 75.
Commenting on the study's findings, Leonard G. Gomella, MD, chairman of the symposium's program committee, said the task force chose 75 years as the cutoff because that is when the average man in the United States reaches his 10-year life expectancy.
Caution should be exercised, however, in making broad determinations about men who have 10-year life expectancies, said Dr. Gomella, chairman of the Department of Urology and Associate Director of the Kimmel Cancer Center at Thomas Jefferson University in Philadelphia.
“They're not all the same,” Dr. Gomella said. “Older men do die from aggressive prostate cancer. While we can't say that screening will eliminate the risk of death in these men, certainly to ignore the men in that older age group who may ultimately suffer from prostate cancer at this point in time seems a little bit premature. Having said that, the 10-year life expectancy and looking at patients' overall health is very important in deciding when you stop screening.”
He pointed out that the life expectancy of men in the United States is going up dramatically in part because improvements in cardiovascular care have reduced their risk of dying from heart attacks and strokes.
Dr. Gomella said he thinks that in the next couple of years PSA screening will used more thoughtfully and providers and patients will be engaged in more dialogue in deciding whether screening is the right thing to do given a patient's age and health status.
The symposium is co-sponsored by the American Society of Clinical Oncology, the American Society of Radiation Oncology, and the Society of Urologic Oncology.