Benefits of PSA screening

Older men (aged 70 to 74 years) are nearly twice as likely as younger men (aged 50 to 54 years) to get PSA screening, but less likely to benefit, according to a recent Journal of Clinical Oncology study by Drazer and colleagues. The authors were also able to determine 5-year life expectancy and found that even 30% of men aged 70 to 74 with low life expectancy were still screened with PSA in the past year. As we know, prostate cancer screening is generally recommended to cease when life expectancy is no longer at least 10 years. I suspect the problem here is either the difficultly providers have with life expectancy determination, or a lack of time to discuss the sometimes difficult topic of ceasing cancer screening for someone with competing causes of mortality. However, PSAs frequently lead to prostate biopsies and repeat lab evaluations, and even prostate cancer treatments, which are not trivial when one is dealing with other life-limiting illnesses, doctor visits and hospitalization, and when we are discussing a screening tool with a modest benefit for all men, especially older men. I wonder if there is a proportion of men who have PSAs for other reasons, as well, such as recurrent urinary tract infections. Presumably that is not the majority of these PSA checks, however.