Many elderly men undergoing unnecessary PSA screenings

A new study on the use of PSA-based prostate cancer screening in the United States has found that many elderly men may be undergoing unnecessary prostate cancer screenings. At the same time, a significant percentage in their fifties are not being screened.

Using data from surveys conducted in 2000 and 2005, University of Chicago researchers report that nearly half of men in their seventies underwent PSA screening in the past year-almost double the screening rate of men in their early fifties. Further, men age 85 years and older were screened just as often as men in their early fifties.

"Our findings show a high rate of elderly and sometimes ill men being inappropriately screened for prostate cancer," said senior author Scott Eggener, MD. "We’re concerned these screenings may prompt cancer treatment among elderly men who ultimately have a very low likelihood of benefiting the patient and paradoxically can cause more harm than good. We were also surprised to find that nearly three-quarters of men in their fifties were not screened within the past year."

For the study, which was published online in the Journal of Clinical Oncology (March 28, 2011), Dr. Eggener and colleagues examined results from health surveys of randomly selected households conducted in 2000 and 2005 as part of the National Health Interview Survey. In addition to reviewing survey data, the team calculated the estimated 5-year life expectancy of each man over 40 years of age who had received a PSA test.

In all, 2,623 men age 70 years and older were included in the analysis, while nearly 12,000 men between the ages of 40 and 69 served as controls.

The overall PSA screening rate within the past year for men age 40 years and older was 23.7% in 2000 and 26% in 2005. The PSA screening rate was lowest in the 40 to 44 age group (7.5%). Researchers found that the PSA screening rate was 24% in men ages 50 to 54 years, increasing with age until a peak of 45.5% in ages 70 to 74 years. Screening rates then declined with age, with 24.6% of men age 85 years or older reporting being screened.

The authors suggest that physicians should be more selective in recommending PSA testing for older men and consider more routinely screening younger, healthier men who are most likely to benefit from early prostate cancer diagnosis.