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.
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Does anyone answer the question of “Well, perhaps the 75-year-old wants to know if he has prostate cancer not because he’s planning treatment but, well, to just know?”
— AlexMaybe I missed something, but I didn’t quite get how it could be harmful to continue getting the test. You mentioned side effects of treatment, but those can be discussed when the decision needs to be made about whether to start aggressive treatment or not. And as some of us become more health conscious and live healthier lifestyles and as medicine continues to progress, those of us in our 20s and 30s now may live well into our 90s. But if screening stops at 75 and disease can start to affect quality of life within 10 years, that could cut short our final years quite significantly. Doctors and patients should be discussing screenings on a case-by-case basis, and err on the side of continuing screening unless it truly is directly harmful.
— ConfusedMales in my family tree have all lived to ages of 97+ years. I am 84 and will continue having PSA tests done annually to clearly establish its value for persons in this age group/
— paul j. bockenstedtOne thing you can be sure of is that right after they have whined, then screamed and cajoled, and finally convinced EVERYBODY to ” take an aspirine a day” ( whatever the flavor of the decade is ) then they will completly REVERSE themselves - and these are the people we ( and they, as well ) think are GOD…
— FredI am 90 years old and I just turned down a recommended exam of my urinary tract to determine if I have any cysts (cystcopy)or tumors. I feel that at my age such procedure is worthless and is
— Leonard Howelljust another way for doctors to bill my HMO for
unnecessary charges, as well as charge me my share. Although I have had many blood tests for psa, I believe I should have protested this years
ago.
I am a Urologist well versed in these data. All screened populations who have been studied show better survival and are diagnosed at an earlier stage. Prostate cancer is the number one diagnosed cancer in men and the number two cause of cancer death. This is important because many men who die OF prostate cancer are statistically or officially designated as having died of other causes, namely, cardiac or respiratory causes.
— sidney goldfarb md facsPeople who have a high grade, high Gleason score, are at more risk than a low grade cancer. The patient won’t know this unless they get a biopsy, after a screening PSA.
Finasteride has been shown and Avodart probably will be shown to reduce the risk of getting prostate cancer and have the patient void better as their prostate enlarges as they get older.
I had a 107 year old die of very quickly progressing prostate cancer but the death registrar refused to accept prostate cancer as the cause of death, probably because of article such as this one. I insisted on a correct cause of death be recorded.
thanks
I’m not giving up the annual PSA. Denial is utter idiocy. Were I to get an elevated level, like Senator Kennedy with his brain cancer, I’d seek advice from the best people. More likely than not most seniors with elevated levels have low grade indolent prostate cancers. But what a waste to die prematurely not knowing of a treatable aggressive tumor.
— MARK KLEIN, M.D.Not test PSA after 75? Ever watch anyone suffer from the bone, and then brain cancer resulting from Prostate Cancer? Not the way I want to go!
— John FlanaganThe article says “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.” Someone’s blowing smoke! After 75 I don’t need the agony of dying of a cancer that can be prevented.
FROM TPP — Nobody is saying prostate cancer shouldn’t be treated after 75. Of course it should, but there’s no evidence to show that screening past this age offers any benefit at all. If the cancer is there and meaningful, it will likely be found without screening.
Anybody that gives up the PSA test based solely on age is crazy! My husband took his first PSA test at 41. According to the “experts” he was barely old enough to even be considered for the test. GUESS WHAT?? Yeah, his test came back at a 5. They redid the test, same result. More extensive testing showed he had developed cancer in about a quarter of his prostate! He had the radical prostate surgery. When the pathology report was complete, turns out his cancer was of the very aggressive type and (this is the doctor’s exact quote) “would have been a serious life threat within a year”. Which translates to … you’d have been outta here in a year!
Men, don’t let someone else decide when you should stop thinking your life is important! If you’re 80 and still healthy, GET THAT TEST! You could easily have another 20 years of healthy living left. My granddad was 99.5 before he even got to the point where he couldn’t drive. At 95 he could still out drive any 30 year old on the planet!!
Stay healthy guys…your family wants (and needs) you around!
— kdThis is, in my opinion a continuing foray on men’s health in this country. As a medical student I can definitely say there is no clinical harm whatsoever in having your PSA when you are past the age of 70.
Interesting how we have federal programs for women’s health (thank Lord) but the men’s health program is but a footnote on the women’s health page. (1,2)
Political correctness runneth amuck both in government and the world of academia. Until this virus known as PC is squashed, there will be no equality of health care.
Still think I’m wrong? Look up the references I’ve listed in this email then ask yourself this question, “How many women’s hospitals are there in the US alone?”
A: Over 50 at last count
Now ask yourself this question, “How many Men’s hospitals are there?”
A: 0
1. http://www.fda.gov/womens/default.htm [ Food and Drug Administration - Office of Women's Health
2. http://www.4woman.gov/mens/ [Men's health page on 4Women ]
— Nicholas DonovanMy husband, who is 83, has had the PSA test for years AND 2 yrs ago the urologist discovered the cancer. After checking to see the cancer has not spread beyond the prostate, Paul began treatments. It is approved by Medicare and is not very invasive. A blood test is taken, and about a week later a large needle is inserted in his lower area after it has been “deadened”. It is checked every 3 mos.(I think) and the same procedure is done IF the lab results show it necessary. The urologist said he may suffer “hot flashes” or other symptoms like women during menapause. Paul will NOT die from prostate cancer….but WITH it! Medicare pays all charges. I DEFINTELY urge all wives to make their husbands continue receiving the PSA regardless of age.
— Jane GuernseyThis is suspect. The line “the chances are more that screening is going to harm you” confuses me. What is the harm that’s going to happen to drawing blood and running the test? And the ‘harm’ done by the side effects of treatment is the alternate to dying from the cancer - shouldn’t I get that choice?
Cynical response: insurance companies don’t want to fund the test and are behind this strange logic.
FROM TPP — You do have the choice and as the article noted, there is no indication medicare is going to change its policy on paying for this. If you want the test you can have it. The downside is that they may find cancer that doesn’t matter. Not only is there stress and anxiety associated with this, but biopsies are unpleasant and there will be continued treatment for a disease that often is, essentially, harmless. But the treatment itself does harm, potentially leaving you impotent, with hot flashes, loss of muscle mass and osteoporosis that could then lead to a broken hip and a high risk of dying as a result. At this age, there is a high chance the cancer itself will not affect your life, but the treatment will.
— John TennyWhat seems odd to me about this recommendation is that it’s not the screening that causes the problems, it’s the treatments. If prostate cancer really progresses so slowly, why not issue new guidelines which discourage treatment in patients over 75 whose cancer is not advanced? That would address the actual problem.
— AshleyAnother charming aspect of our two-tier society that assumes a person can just merrily pick up the phone and “ask your doctor”. I’m 56 yrs old, have zero medical insurance, haven’t seen a physician in years. Lately I’ve been having difficulty urinating, and I’m worried about my prostate. But this is America, so tough luck for me, huh, cause I have no idea how I can go get one of those PSA tests.
— RussI have been under the care of a Urologist for over 5 years with an elevated PSA in the 4 to 6 range. It has ramped up to those levels over this time period but seems to have stabilized. I have had two biopsies, both with perfect prostate cell findings. You mention, “the chances are more that screening is going to harm you.” How so? I am worried that the thrity some tissue cores extracted from my prostate. How does that effect my prostate, scar tissue? Is this the negative you are referring to? My doctor tells me I am the typical case. Elevated PSA but no cancer. He plainly states the PSA is a bad test but it is the only test we have. I have known men with smaller PSA values than I and cancer was found. My decision as to what threshold I will allow my PSA to elevate to before I consent to another biopsy. I am 58 years old. I am thinking I will tolerate my PSA increasing by 25% before I undergo that unpleasant experience one more time.
— JalleyThanks to good genes and eating habits and not smoking (not to adequate exercise), I’m in excellent health at 72. Different statistics indicate I may live into my 90s. Thus, the math suggests that I may be wiser to continue being tested for prostate cancer until I’m 85.
— Frank HenningerThis is nonsense. How can less information possibly be better than more information?
— GeoffHaving the test doesn’t force one to act in any particular way if the test comes back positive - you can still choose not to be treated.
This is just another way to use statistics to justify saving some money.
The purpose of the PSA test is to identify elevated test levels indicating the possibility of prostate cancer.
While many cases of prostate cancer develop very slowly and the best treatment may be no treatment, there are strains of prostate cancer that develop very quickly and can cause death in a relatively short time period.
The patient and doctor can discuss and decide if further testing is necessary and discuss appropriate treatment or non-treatment options.
Avoiding the test simply issues a death warrant to those patients with elevated PSA levels by effectively precluding and denying treatment that could save their lives.
Once again, we have another scam by the medical insurance provider green eye and bonus calculator staff proposing refusal to pay for a non-intrusive and inexpensive test that would indicate the possible existence of prostate cancer.
The proposal has nothing to do with medical decisions that belong to the patient and doctor and everything to do with profit, bonuses, and greed.
— Alan LidstoneWith the alternative of bone cancer, test please. That federal committee says treatments were worse? May the gods exact a suitable revenge.
— Ron EmerineAlthougth not yet seventy-five, I am not that far away. I will still insist on a PSA test as long end of life does not seem close, even if the test is not covered by insurance. I would, hovwever, if cancer were detected, thoroughly conisder all available information before deciding what measure, if any to take. Having healthy relatives in thier mid-nineties, seventy-five does seem like an indication that the end is near.
— VanMy father had regular PSA tests throughout his later years and was 84 when he was diagnosed with prostate cancer. He opted for hormone and radiation therapy, which “cured” him. My father lived to age 93. He probably would not have made it as far if he had his testicles removed the way his first doctor recommended. He got a second opinion and was glad it worked out.
I don’t believe it’s advisible to stop getting the PSA tests after a certain age. You never know.
— Jon“What we find in practice is that adds additional time and effort that’s not compensated…it will be just as easy to not do the blood test.’’
And, of course, it’s all about making it easier for “providers,” those HMO flunkies who used to be known as “doctors.”
— BobI am 72 years old and insist that my doctor do a PSA test every year at my annual physical. I personally know five men that have had high PSA numbers. They have all turned out to have prostate cancer after further testing. Their treatments have been successful and it has certainy prolonged their lives.
Even if my HMO refuses to pay for the PSA blood work I will pay for it myself. The HMO’s are only concerned about the bottom line and not the PATIENTS health. This seems foolish to me since treatment for advanced cancer will cost them much more than the simple PSA blood work.
SGH
— Sanford HarrisThis new study will once again stir up the debate over PSA screenings for senior men. My professional experience over the past 20 years is that the majority of these men will continue getting screened until some other more serious condition becomes a higher priority in their lives. As long as Medicare continues to cover PSA blood tests, men and their urologists will likely
continue testing for prostate cancer and seek some type of treatment.In my experience, men in their 80s have insisted on being treated when they have positive biopsies. And so do their spouses.
Leonard Arzt
— Leonard ArztNational Association for Proton Therapy
I’m 80; my last PSA test was about 18 years ago. The results were 2.6. I stopped getting tests after that. My older brother informed me that his PSA was higher than 4.0 and he became concerned. In fact he got biopsies and the indications were that he had some cancer. He made half hearted attempts at mitigating the cancer; continued getting PSA’s and biopsies; worried constantly from the age of 79 until he died - of prostate cancer of the bones - at 83. Along the line he also had a T.U.N.A procedure which I believe caused the cancer to spread as well as suffering a serious case of septicemia from the TUNA procedure.
I decided not to get PSA’s and not have to face the dilemma of what to do. So, I ignored the whole mess and do not lie awake nights worrying about it. Unfortunately, some people believe they will live forever as long as “they catch any malfunction early.” That is utter nonsense; there is a time to live and a time to die.
— Edward Foss