Safe to discontinue screening in men older than 75 with PSA <3 ng/dL

During the remainder of their life, men aged between 75 and 80 years with PSA levels <3 ng/mL were unlikely to be diagnosed with or die of aggressive prostate cancer, according to data from a longitudinal cohort study. Based on this finding, researchers suggested that PSA testing may be safely ceased in this population.

The study included 122 men with and 727 men without prostate cancer whose serial PSA measurements were obtained as part of the Baltimore Longitudinal Study of Aging. The primary endpoint was the proportion of men by PSA and age who died of or developed aggressive prostate cancer.

No prostate cancer deaths occurred among men between the ages of 75 and 80 years with a PSA <3.0 ng/mL, according to the researchers. However, the probability of death from prostate cancer continued to increase among men of all ages with a PSA ≥3.0 ng/mL (P<.001).

After age 75 years, the time to death or diagnosis of aggressive disease was not different between PSA categories of 3 ng/mL to 3.9 ng/mL and 4 ng/mL to 9.9 ng/mL (P=.634). However, the researchers reported longer time to death or diagnosis of high-risk disease for the PSA category <3 ng/mL compared with ≥3 ng/mL (P=.019).

“These men may represent an ideal target group for discontinuation of PSA testing, which could dramatically reduce the costs associated with screening as well as the potential morbidity of additional evaluations and/or treatment in a population unlikely to experience benefit,” the researchers wrote.

J Urol. 2009;181:1606-1614.