Recommendations Against Routine Prostate Cancer Screening of Elderly Men Largely Ignored

The effect of guidelines advising against the routine use of prostate-specific antigen (PSA) testing to screen for prostate cancer in elderly men has been minimal, according to a study published September 1, 2014, in JAMA Internal Medicine.

The researchers found that an estimated 17 million men 50 years or older who don’t have a history of prostate cancer or prostate problems still report undergoing PSA screening. The use of the test is controversial despite being associated with a significant improvement in 5-year prostate cancer survival rates since the FDA approved PSA testing in men without symptoms a decade ago.

The test frequently registers false-positives, which causes patients who do not have a prostate malignancy to undergo unnecessary treatment that carries side effects such as impotence and urinary incontinence.

The researchers examined the 2012 Behavioral Risk Factor Surveillance System to analyze screening rates according to age, race and/or ethnicity, education, income, location, insurance status, health care access, and marital status. The study found that higher screening rates were most strongly associated with patients who have access to regular health care, an annual income greater than $75,000, a college education, and health insurance, and who were between 70 and 74 years of age.

Men between the ages of 50 and 54 years were found to be the least likely to report PSA screening, despite recommendations for screening in that age group from several medical organizations. The researchers noted that a high degree of variability in state-by-state testing rates represented an alarming finding, considering the ongoing disagreement among experts for PSA screening. SPT