Elderly men screened for PSA too often

NEW YORK (Reuters Health) - The findings from a new study suggest that too many elderly men in poor health are undergoing prostatic-specific antigen (PSA) screening. In this group, the known harms of screening, such as additional procedures for false-positive results, almost certainly outweigh the very slim chance of receiving a survival benefit.

"Not a single professional organization, physicians' group, or prostate cancer advocacy group advocates PSA screening for frail, elderly men, and yet we are doing it," lead author Dr. Louise C. Walter, from the San Francisco VA Medical Center, said in a statement.

As reported in the Journal of the American Medical Association, the researchers assessed PSA screening among 597,642 male veterans, 70 years of age or older, who were seen at a VA Medical Center in 2002 and 2003. None of the subjects had a history of prostate cancer, elevated PSA levels, or prostate cancer symptoms.

The subjects were divided into four age groups: 70 to 74, 75 to 79, 80 to 84, and 85 years of age or older. In addition, an assessment of any conditions or illnesses was conducted to divide the subjects into three health categories: best, average, and worst.

Fifty-six percent of the men underwent PSA screening in 2003, the report indicates.

PSA screening dropped with advancing age, yet there was little difference in screening rates between men in the best health category and those in worst health category.

In the oldest age group, men in worst health category actually had a slightly higher screening rate than those in best health category: 36 percent vs. 34 percent.

Some subgroups of patients in the worst health category had screening rates over 60 percent.

Further analysis showed that health status had only a minor effect on PSA screening and was actually less influential than certain nonclinical factors, such as marital status and region of the country.

"We need to educate the public more about the downsides of screening tests," Walter noted. "This is isn't about cost-cutting. It's about not doing harm by not subjecting people to tests and procedures they don't need."

SOURCE: Journal of the American Medical Association, November 15, 2006.