From the Guidelines
For an 83-year-old male, PSA screening is generally not recommended. The benefits of PSA screening in men over 70-75 years of age are limited because the potential harms of screening (including false positives, unnecessary biopsies, overdiagnosis, and treatment complications) typically outweigh the benefits 1. Prostate cancer in elderly men is often slow-growing, and most men this age are more likely to die from other causes before a prostate cancer would become clinically significant or life-threatening.
Key Considerations
- Life expectancy is an important consideration in screening decisions, and at 83 years old, even if prostate cancer were detected, the patient might not benefit from treatment due to the indolent nature of many prostate cancers and competing health risks.
- The American College of Physicians recommends that clinicians should not screen for prostate cancer using the prostate-specific antigen test in men over the age of 69 years, or men with a life expectancy of less than 10 to 15 years 1.
- However, if the patient has specific urinary symptoms or concerns, a clinical evaluation focusing on those symptoms would be appropriate rather than routine PSA screening.
Individualized Decision Making
The decision should ultimately be individualized based on the patient's overall health status, comorbidities, and personal preferences after discussing the limited benefits and potential harms of screening at his age 1.
Prioritizing Patient Outcomes
In prioritizing morbidity, mortality, and quality of life, it is essential to weigh the potential benefits of PSA screening against the potential harms and to consider the patient's individual circumstances and preferences.
From the Research
Screening for Prostate Cancer in an 83-Year-Old Male
- The decision to screen for prostate cancer in an 83-year-old male is controversial among health professionals, as evidenced by the conflicting research studies regarding the efficacy of PSA screening in improving survival rates 2.
- Some studies suggest that initiating screening at age 40, to obtain a baseline value, is recommended for primary care providers and is supported by the most recent evidence 2.
- However, other studies have shown that PSA screening can be effective in detecting prostate cancer at a localized stage, with 99% of cancers diagnosed being at a potentially curable stage 3.
- The use of digital rectal examination (DRE) as an adjunct to PSA screening has also been investigated, with some studies suggesting that DRE can be useful in detecting clinically significant prostate cancer, particularly in men with elevated PSA levels 4, 5.
- A study published in 2018 found that DRE demonstrated prognostic usefulness when PSA was greater than 3 ng/ml, but had limited usefulness for PSA levels less than 2 ng/ml and marginal usefulness for PSA levels between 2-3 ng/ml 5.
- Another study published in 1993 suggested that the combined use of DRE and PSA testing provides a more complete evaluation of the prostate gland for malignant involvement, and that TRUS is best reserved for patients with abnormal results of DRE or increased PSA values 6.
- Overall, the evidence suggests that PSA screening can be effective in detecting prostate cancer, but the decision to screen should be made on an individual basis, taking into account the patient's age, health status, and other risk factors.
- In the case of an 83-year-old male, the benefits and risks of screening should be carefully weighed, and the decision to screen should be made in consultation with a healthcare provider 2, 3, 6, 4, 5.