Men aged 70 years or older continue to be overscreened for prostate cancer despite US Preventive Services Task Force recommendations against routine PSA screening for men in this age group, according to investigators.
PSA screening in older men who are unlikely to benefit from prostate cancer treatment exposes these men to anxiety, invasive biopsies, and possible overtreatment, they noted.
The latest findings are from a telephone survey of 32,306 men from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a nationwide annual survey conducted by the Centers for Disease Control and Prevention. PSA testing within the past 2 years was reported by 55.3%, 52.1%, and 39.4% of men aged 70-74, 75-79, and 80 years or older, respectively, Brent S. Rose, MD, of the University of California San Diego in La Jolla, and colleagues reported in JAMA Network Open. White men had the highest PSA screening rate (50.7%), whereas Native American men had the lowest (32.0%).
In a multivariable regression model, married men and men with a primary care physician, a post-high school educational level, and income of more than $25,000 per year had increased odds of being overscreened for prostate cancer.
Discussing PSA testing advantages with a clinician was significantly associated with 9.1-fold increased odds of recent screening, Dr Rose’s team reported, whereas discussing PSA testing disadvantages had no effect.
“The results of this study can inform interventions to disincentivize low-value screening,” according to Dr Rose’s team. “For instance, given the higher educational levels among respondents who may overuse PSA screening, direct patient education on the risks of PSA screening may be beneficial for males older than 70 years.”
The US Preventive Services Task Force advises against PSA screening in men older than 69 years due to the risk of false-positive results and overdiagnosis of indolent disease. The American Urological Association (AUA) recommends against routine PSA screening of men older than 70 years. However, the AUA acknowledges that some men age 70 years or older in “excellent” health may have more than a 10-15 year life expectancy and might benefit from screening.
According to an AUA panel: “Men age 70 years and older who wish to be screened should do so after an understanding that the ratio of benefit to harm declines with age, although there is evidence that men with high-risk disease in this age range may benefit from early diagnosis and treatment over a decade or less.”
Among the current study’s limitations, the investigators could not distinguish the reason for PSA testing, which may have included monitoring of prostate cancer, benign prostatic hyperplasia, or prostatitis. Respondents were grouped by age categories rather than specific age leaving open the possibility that some men in the 70-74 years age bracket could have been age 69 at the time of PSA testing.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Kalavacherla S, Riviere P, Javier-DesLoges J, et al. Low-value prostate-specific antigen screening in older males. JAMA Netw Open. Published online April 3, 2023. doi:10.1001/jamanetworkopen.2023.7504
Carter HB, Albertsen PC, Barry MJ, et al. Early detection of prostate cancer: AUA guideline. J Urol. 2013;190(2):419-426. doi:10.1016/j.juro.2013.04.119