This article is more than 5 years old. Information may no longer be current.
In light of the USPSTF recommendations, should men older than 75 years be screened for prostate cancer?
Click Here to Manage Email Alerts
Older men should not be screened
At age 75 and older, the odds that something else will cause the death of a man, rather than prostate cancer, are high. If a patient has symptoms suggesting prostate cancer, he should see a doctor; men in their 50s and 60s should be educated about what symptoms to look for. It is important to understand, however, that if they develop those symptoms it is no longer a “screening” exercise but instead is the investigation of a specific symptom. “Screening” really refers to the testing of healthy people without any symptoms or evidence of a particular disease. If a man notices slowing of his urinary stream or blood in the urine and gets a digital rectal exam or a PSA check, that is not “screening” (because he is checking out a specific symptom).
|
|
For the person who urinates normally, has no blood in their urine, can get an erection and doesn’t have a family history of prostate cancer, there is no strong evidence at the present time that screening will save lives in the majority of those screened. This is because prostate cancer is such a variable disease, and so many cases run very slow courses.
Level-1 evidence to showing that screening will save lives does not exist in prostate cancer. If someone wants to be screened, that is very reasonable as long as they understand that we may find a cancer that does not necessarily need to be treated. But once a patient knows he has cancer, Pandora’s Box is opened.
I have never held the view that screening is not useful; I have simply said it has not been proven useful and that is a very important distinction. For example, for many years, people had annual chest X-rays to screen for lung cancer as it seemed sensible that this would allow early pick-up; however, a randomized trial of annual chest X-rays showed that they did not actually contribute to improved survival, and this practice was stopped (after it had cost the community millions of wasted dollars). The USPSTF has picked 75 as an advanced age and have said these men are older and are more likely to be harmed than helped by screening; they actively discourage making 75-year-olds routinely, without symptoms, get a PSA test, for the reasons discussed above and I think that makes a lot of sense.
Derek Raghavan, MD, PhD, is the Chair and Director of the Cleveland Clinic Taussig Cancer Institute and the M. Frank and Margaret Domiter Rudy Institute Chair.
Only limited number will benefit
|
|
We can say that there are probably some men aged 75 and older who will benefit from having a prostate cancer discovered, but that number is probably very small.
A more reasonable approach would be, instead of saying everyone over the age of 75 should be screened, that look at their PSA history.
PSA is such an incredibly strong predictor of not only the development of prostate cancer but also death from prostate cancer. A man who has maintained a very stable PSA during his life probably does not need to be screened and is someone who is probably not going to get into trouble in terms of developing a lethal cancer.
On the other hand, someone who clearly has an elevated PSA, especially one that’s rising, may be someone to keep a close eye on.
I can’t say that all men older than 75 should not be screened; I don’t think that’s true. Instead, we should use the information available to us to determine whether or not it’s safe to discontinue screening.
I think virtually everyone would agree that the overwhelming majority of men older than 75 who are diagnosed with prostate cancer are not going to benefit from treatment.
H. Ballentine Carter, MD, is Professor of Urology and Oncology at Johns Hopkins Medicine and Director in the Division of Adult Urology at Brady Urological Institute.