The decision not to screen elderly men is based on several factors, including the lack of evidence that treatment improves prostate cancer mortality in elderly men. However, with some studies suggesting that many elderly men are being screened, it is not clear whether screening is being initiated at the request of the patient or by the physician. In addition, there is little information about whether physicians are discussing the risks and benefits of screening with patients before testing.
Grace Lu-Yao, Ph.D., of HealthStat in Princeton, N.J., and the Cancer Institute of New Jersey, New Brunswick, Therese A. Stukel, Ph.D., of the Institute for Clinical Evaluative Sciences in Toronto, and Siu-Long Yao, M.D., of the Cancer Institute of New Jersey, reviewed information about screening in a nationally representative sample of 7,889 men who participated in the 2000 National Health Interview Survey.
Approximately 32.5% of men ages 75 or older reported that they had undergone a PSA screening test during the preceeding 12 months, which on the national level would represent approximately 1.47 million U.S. men. Among screened elderly men, 88.4% reported that their doctor first suggested screening and 66.5% reported having a discussion about the advantages and disadvantages of the test with their doctor before the screening was performed.
"It is somewhat surprising that so many physicians would suggest screening (or be perceived as suggesting screening) in elderly men when the benefits have not even been established among younger men," the authors write.
They acknowledge limitations with the survey, including errors in self-reporting or recall bias. For example, some patients may have been unaware that they received PSA testing, leading to an underestimation of the rate of testing. The authors say that screening a population that is unlikely to benefit may deplete health care resources, potentially harm the patient, and generate unnecessary anxiety.
"Ultimately, decisions regarding the appropriateness of PSA screening in elderly men and the allocation of health care resources will have to be made by patients, physicians, and society working together," they write. "Until such decisions can be made, recognizing and understanding the reasons for the high rates of PSA screening in elderly men may provide insights into how patients (and physicians) use, interpret, and apply medical data. Such information may be critically important for the development of strategies designed to increase understanding of the risks and benefits of PSA screening in elderly men."
Contact: Jennifer Ryan, Cancer Institute of New Jersey, 732-235-9891; fax: 732-235-9795, email@example.com.
Lu-Yao G, Stukel TA, Yao S. Prostate-specific antigen screening in elderly men. J Natl Cancer Inst 2003;95:1792–7.
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