Will Older Men Give Up the PSA Test?

06 aug 2008--Men ages 75 and older should not be screened for prostate cancer. This is the important and definitive conclusion of the U.S. Preventive Services Task Force, which for the first time has made a specific recommendation about the value of screening for prostate cancer.
To many doctors, the new guidelines will not come as a shock. Quite a few believe that because prostate cancer often progresses slowly, not causing symptoms for 10 years or longer, it’s inappropriate to look for it in healthy older men. A man aged 75 or older may well die of another cause long before his prostate cancer becomes a problem. And treatment of prostate cancer has significant drawbacks, often leading to impotence, incontinence and a variety of other complications that reduce a patient’s quality of life.
But what doctors know and what happens in practice often are two different things.
Prostate screening involves a simple blood test to check for prostate-specific antigen, or PSA. Many doctors find it easier just to do a PSA test than take the time to explain the pros and cons to a patient. Patients themselves, many accustomed since their late 40s or early 50s to getting tested, aren’t always comfortable with the idea of stopping the screening once they reach older age.
And interestingly, doctors say the wives of many older men, themselves firm believers in screening for cervical cancer and breast cancer, sometimes push their husbands and doctors to continue screening for prostate cancer.
The statistics on inappropriate screening are surprising. In one study of 600,000 men treated by the Veterans Administration, screening rates were 64 percent for men ages 70 to 74, 56 percent for men ages 75 to 80, 45 percent for men ages 80 to 84 — and a surprising 36 percent for men ages 85 and older.
“For some men, it’s a tough issue to face,'’ said Dr. Ned Calonge, chairman of the task force and chief medical officer of the Colorado Department of Public Health and Environment. “It isn’t that we know when you’re going to die, or that it’s all over so don’t worry about anything else…. We’re very poor at predicting how much longer you’re going to live. If you take it from the standpoint of risk versus benefit, the chances are more that screening is going to harm you.'’
Dr. Calonge hopes the new guidelines will trigger another round of discussion about PSA testing between doctors and patients.
“Even before this, we were really trying to recommend to physicians that given the uncertainty about benefit for screening, you should really discuss on an individual basis the pros and cons of screening,'’ Dr. Calonge said. “What we find in practice is that adds additional time and effort that’s not compensated as part of normal clinical care. It’s easier to just draw the blood test. I think what we hope now is that it will be just as easy to not do the blood test.'’
What do you think? Will you be ready to give up PSA testing when you or your spouse reaches the age of 75? To learn more about the new guidelines, click here to read the full story. Then join the discussion by posting your comments below.