Oncology Central

Recommendations against screening for prostate cancer in the elderly: is anyone listening?

A recent study carried out by a team of researchers, including lead author Jesse Sammon (The Henry Ford Vattikuti Urology Institute, MI, USA), has found that recent guidelines advising against the use of prostate-specific antigen (PSA) testing as a screening tool in elderly men have not been well implemented.

Use of PSA for testing for prostate cancer is US FDA approved and 5-year cancer survival rates have significantly improved since its approval 10 years ago. However, recommendations for less regular use of the test in older men have had little effect according to the study published in JAMA Internal Medicine as a research letter. PSA testing as a screening tool can yield false positive results, often meaning that a patient may undertake treatment for a malignancy they do not have, which can often result in urinary incontinence and impotence.

The researchers used data from the largest continuous health survey – the 2012 Behavioral Risk Factor Surveillance System. Age, race and/or ethnicity, education, income, residence location, insurance status, access to regular health care and marital status were all studied.

It was found that approximately 17 million men who were aged 50 years or older who did not have a history of prostate cancer underwent screening. The researchers also found that screening was more prevalent in groups that had good access to regular health care, an income >$75,000, college education, health insurance and individuals between the ages of 70 to 74 years old.

By a very small fraction, the next highest rate of screening was in men in the 65–69 year age group. Men aged 50–54 were found to be the least likely to report PSA screening, despite some professional medical organizations recommending that screening would be beneficial for this age group.

When analyzing self-reported PSA screening between states, they also found that the highest rate of screening was 59.4% in Hawaii and lowest, at 24.5% in New Hampshire, and were surprised by the extent of variability. “This was another concerning and surprising study finding. It’s alarming that the prevalence of PSA screening can double from one state to the next”, Sammon commented.

The group further explained that “both the considerable disagreement among experts and the conflicting recommendations on PSA screening. Taken together, these results suggest that national guidelines have had a limited effect on clinical practice among health care providers.”

Sources: Sammon JD, Pucheril D, Diaz M et al. Contemporary nationwide patterns of self-reported prostate-specific antigen screening. JAMA Intern. Med. doi:10.1001/jamainternmed.2014.4117 (2014) [Epub ahead of print]; Henry Ford Health System news release




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