From the Guidelines
For patients over 65 years old, it is generally recommended to discontinue routine Prostate-Specific Antigen (PSA) screening, as the potential benefits of screening in this age group may not outweigh the risks of overdiagnosis and overtreatment 1. However, for patients with a life expectancy of more than 10 years, a shared decision-making approach with their healthcare provider is recommended, taking into account their individual risk factors, health status, and preferences 1.
Key Considerations
- The potential benefits of PSA screening in men over 65 years old are limited, and the risks of overdiagnosis and overtreatment are significant 1.
- A shared decision-making approach is essential to ensure that patients are fully informed of the potential benefits and harms of screening 1.
- If screening is decided upon, it should be done annually, with a PSA threshold of 4.0 ng/mL or higher to prompt further evaluation, as using a lower threshold may result in more false-positive results and unnecessary biopsies 1.
- A digital rectal examination (DRE) may be considered as part of the screening process, although its benefits and harms are not well established 1.
Patient Factors to Consider
- Life expectancy: Patients with a life expectancy of less than 10 years are unlikely to benefit from screening 1.
- Individual risk factors: Patients with a family history of prostate cancer or other risk factors may benefit from screening, but the decision should be made on a case-by-case basis 1.
- Health status: Patients with significant comorbidities may not benefit from screening, as the risks of treatment may outweigh the potential benefits 1.
- Patient preferences: Patients should be fully informed of the potential benefits and harms of screening and should be involved in the decision-making process 1.
From the Research
PSA Screening in Patients Over 65 Years Old
- The US Preventive Services Task Force (USPSTF) recommends against PSA-based screening for prostate cancer in men 70 years and older, as the potential benefits do not outweigh the expected harms 2.
- For men aged 55 to 69 years, the decision to undergo periodic PSA-based screening should be an individual one, considering the balance of benefits and harms based on factors such as family history, race/ethnicity, and comorbid medical conditions 2.
- A study on discontinuing cancer screening for older adults found that clinicians consider screening cessation differently across multiple cancer screening types, including prostate cancer, and that the benefits and harms of screening are weighed differently for each type 3.
- Active surveillance for prostate cancer may be cost-effective for up to 7 yearly biopsy rounds in men with low-risk disease aged 55-65, but for men older than 65, even one biopsy round may result in quality-adjusted life years lost 4.
- Docetaxel-based chemotherapy has been shown to be active and feasible in elderly patients with castration-resistant prostate cancer, but the optimal treatment of frail patients remains to be established 5.
- A national survey of Canadian primary care physicians found that opinions and practices regarding prostate-specific antigen testing for prostate cancer screening vary widely, with almost equal numbers for or against screening, highlighting the need for objective guidance and input from all stakeholders 6.