From the Guidelines
Annual PSA testing is generally not recommended for men over 70 years old. For most men in this age group, the potential harms of PSA screening outweigh the benefits 1. As men age, especially beyond 70, they are more likely to have slow-growing prostate cancers that may never cause symptoms or affect their lifespan. The testing process can lead to unnecessary anxiety, additional procedures like biopsies, and treatments that may cause significant side effects such as urinary incontinence and erectile dysfunction. These interventions often don't improve overall survival in older men but can significantly reduce quality of life.
Key Considerations
- The potential benefits of PSA screening are limited to men between the ages of 55 and 69 years, with an average life expectancy of more than 10 years 1.
- Men over 70 years old with a life expectancy of less than 10 years are unlikely to benefit from screening and treatment 1.
- The decision to screen for prostate cancer should be individualized based on overall health status, life expectancy, personal preferences, and risk factors rather than age alone 1.
- Some men over 70 who are in excellent health with a life expectancy of more than 10 years, or those with specific risk factors like a family history of aggressive prostate cancer, might still benefit from PSA screening after discussing with their doctor 1.
Harms of Screening
- False-positive results and subsequent biopsies can cause anxiety, infections, and other complications 1.
- Overdiagnosis and overtreatment of prostate cancer can lead to significant side effects such as urinary incontinence and erectile dysfunction 1.
- The harms of screening and treatment are substantial, and the benefits are small, making it essential to weigh the risks and benefits carefully 1.
From the Research
Annual PSA Screening for Men Over 70
- The US Preventive Services Task Force recommends that PSA screening for prostate cancer involve men aged 55-69, based on a personal decision following consultation with a health professional 2.
- For men aged 70 or older, PSA screening should only occur if symptoms exist 2.
- However, studies have shown that PSA screening is most common in men aged 70 or older, which is counter to the US Preventive Task Force recommendation 2, 3.
- A survey study using data from the 2020 Behavioral Risk Factor Surveillance System found that 55.3% of males in the 70-to-74-year age group, 52.1% in the 75-to-79-year age group, and 39.4% in the 80-year-or-older group had recent PSA screening 3.
- Discussing the benefits of PSA testing with a clinician was associated with increased screening, underscoring the potential of clinician-level interventions to reduce overscreening in older males 3.
Factors Associated with Low-Value PSA Screening
- Factors associated with a higher screening rate included having a primary care physician, a post-high school educational level, and income of more than $25,000 per year 3.
- Married respondents were screened more than unmarried males 3.
- Non-Hispanic White males had the highest screening rate, and non-Hispanic American Indian males had the lowest screening rate 3.
- Screening increased with higher educational level and annual income 3.
Detection of Prostate Cancer
- Digital rectal examination (DRE) and prostate-specific antigen (PSA) testing can be used to detect prostate cancer 4, 5, 6.
- The positive predictive value of a suspicious digital rectal examination was appreciable in men with low serum PSA 5.
- PSA in combination with DRE appears to be useful in detecting prostate cancer in its early stages 6.
- However, mass screening for prostate cancer in asymptomatic men cannot be advocated until a decrease in the mortality rate is established by randomized, controlled studies 4.