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Healio
May 01, 2009
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Surveyed population unhappy with USPSTF prostate screening recommendations

American Urological Association Annual Meeting

According to most men surveyed at the Duke University’s annual free prostate cancer screening clinic, screening should not end at age 75 as recommended by the U.S. Preventive Services Task Force. Additionally, researchers from the university reported that men older than 75 have a higher risk for disease and poorer outcomes.

“Almost 80% of the men [surveyed] were not in favor of the government recommendation,” Judd Moul, MD, professor and chief of urology at Duke University and director of the Duke Prostate Center, told HemOnc Today. “They didn’t think it was appropriate to automatically use an age cutoff for screening.”

Moul, who presented the study at the American Urological Association Annual Meeting, and colleagues surveyed 340 men and divided them into two groups based on age (younger than 75 or 75 and older), noncollege graduate or college graduate, self perceived knowledge of disease, awareness of screening guidelines, and opinion on discontinuing screening after age 75.

Comparison of Prostate Cancer-related Measures and Outcomes by Age Group

Younger than 65 65 to 75 75 and older
Median PSA 5.9 ng/dL 7.0 ng/dL 7.6 ng/dL
pT3/4 disease 36.2% 48.2% 54.7%
Pathological Gleason >7 10.3% 15.8% 18.0%
Distant–metastasis-free survival at 10 years 93.8% 92.5% 83.5%
Disease-specific survival at 10 years 96.3% 95.9% 85.9%

Among those surveyed, 78.2% were “upset” about the USPSTF recommendations to discontinue screening among men aged 75 or older. There was no significant difference between education or age among men who were upset. However, self perceived knowledge of disease (P<.001) and knowledge of screening guidelines (P=.006) differed between education groups.

The researchers also used the prostate center’s database to identify a cohort of 4,196 men who underwent radical prostatectomy between 1988 and 2008. The men were stratified by age: younger than 65, 65 to 75 and older than 75 years.

Compared with men younger than 65 and those aged 65 to 75, men older than 75 had higher median PSA, pT3/4 disease and pathological Gleason .7, rate of metastasis and disease-specific mortality (see table).

“It was not appropriate for the USPSTF to draw a line in the sand and use a 75 age cutoff; that’s age discrimination,” Moul said. “They should try to take a more customized approach or make a recommendation that’s more customized based on an individual man’s risk for prostate cancer mortality.” – by Stacey L. Adams

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