Prostate Cancer Screening Guidelines Often Not Followed: Study

Many older men still get unnecessary PSA tests, researchers report

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By Steven Reinberg
HealthDay Reporter

TUESDAY, April 24 (HealthDay News) -- In 2008, the U.S. Preventive Services Task Force recommended against testing for prostate cancer in men aged 75 and older, but new research finds that almost 44 percent of these men are still being screened.

Before the 2008 guidelines were set, about 43 percent of men in this age group opted for prostate-specific antigen (PSA) tests, but the task force found that testing had no effect on longevity and could result in overtreatment with adverse consequences. Meanwhile, the task force drafted a new set of guidelines last October that are even more critical of PSA testing, suggesting it may not have any value for men of any age.

"Patients and providers did not adjust their screening behavior following the last major United States Preventive Services Task Force recommendation, and the effect of the upcoming guideline needs to be monitored," said study author Dr. Sandip Prasad, a urologic oncology research fellow at the University of Chicago Medical Center.

"Many physicians and patients continue to have confidence in PSA screening to prevent death from prostate cancer, and it is incumbent upon the medical community to refine the use of this screening test to minimize overdiagnosis and overtreatment of prostate cancer without losing ground on the progress we have made against the disease," he added.

The findings were published in a letter in the April 25 issue of the Journal of the American Medical Association.

Prasad's team found that the number of older men receiving PSA tests had actually increased to 43.9 percent by 2010. That's more screening than in men in their 40s and 50s (12.5 percent and 33.2 percent, respectively) who are the ones most likely to benefit from early diagnosis and treatment, the researchers said.

Only men aged 60 to 74 were more likely to get a PSA test (51.2 percent), they noted.

To gather the data, the researchers used the 2005 and 2010 Cancer Control Supplements, which are part of the annual National Health Interview Survey.

Because patient data is self-reported, the results likely underestimate the actual number of men getting PSA screening, the researchers noted.

The U.S. Preventive Services Task Force is on the verge of issuing new PSA testing guidelines and, based on early recommendations, the task force now believes the PSA test is ineffective for men of any age.

"Prostate-specific antigen-based screening results in small or no reduction in prostate cancer-specific mortality," the early recommendations conclude, and is associated with "harms related to subsequent evaluation and treatments, some of which may be unnecessary."

Given that the initial public recommendation against routine PSA-based screening generated significant controversy in the fall of 2011, "it is unclear what, if any, changes in PSA screening will result if this recommendation is made final," Prasad said.

Dr. Anthony D'Amico, chief of radiation oncology at Brigham and Women's Hospital in Boston, doesn't think that age is a good indicator of when PSA screening is appropriate.

"I'll make the same comment for Warren Buffet who is 81 and diagnosed with prostate cancer," he said. "I don't look at 75, I don't look at 50, I look at the person. People's age doesn't tell you about their life expectancy -- on average it does, but not everyone," D'Amico explained.

"We should look at an individual's life expectancy, and if it's more than 10 years that's a person who should be screened," he said.

However, the reason the rate of screening has remained the same is because of confusion, D'Amico said.

"Doctors and patients don't know what to think, because there is evidence that PSA works in one study and that it doesn't in another, so rather than change they do what they have been doing all along," he noted.

More information

For more on prostate cancer, visit the U.S. National Cancer Institute.

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