Eight years ago the United States Preventive Services Task Force recommended against routine use of PSA screening in men older than 75. PSA screening is a blood test that measures prostate-specific antigen.
In 2012, the task force recommended against all routine PSA testing, regardless of age.
Most prostate cancer develops slowly therefore it doesn’t typically threaten survival or cause troubling symptoms for eight to ten years. Even medical associations that disagree with some of the 2012 conclusions discourage PSA testing for men with limited life expectancy.
Many conditions besides cancer can produce an elevated PSA reading, including an enlarged prostate. The chances of doctors detecting prostate cancer in older patients are so small. For low-risk prostate cancer, the treatment of choice is observation.
After the task force report in 2008, researchers reported virtually no change in screening rates among older men. The guidelines in 2012 had greater impact.
Still, research and studies have found only modest declines, or no significant declines, in the group with perhaps the least to gain and a lot to lose from PSA screening: men older than 75.
Researchers analyzed data from the National Health Interview Survey and found that from 2010 to 2013, the screening rate in that age group fell from 44% to 37%. Although this is a statistically significant decrease, it is smaller than the drop for younger men.
Among men with a high risk of mortality within nine years, almost 38% of those older than 75 were screened. The vast majority of men being tested in their 80s were also likely to die within nine years.
Such widespread screening is a poor use of health care resources and poor decision-making.
PSA tests lose accuracy at older ages. Abnormal results generally return to normal in subsequent testing.
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