Harvard Men's Health Watch

When is it time to stop being checked for prostate cancer?

Image: Thinkstock

It's essential to be fully informed about the potential risks of PSA testing, which include
complications from biopsies and teratments.

The answer depends on your current health and your level of concern about cancer.

Routine PSA testing to check for prostate cancer is no longer recommended for most men. But despite what the experts suggest, many men continue to opt for annual PSA tests. This includes a surprisingly large number of men in their 70s. In a recent study in the journal Cancer, more than half of a group of men 75 and older had PSA tests and biopsies.

These men have placed their hope in the value of early diagnosis and treatment, yet stand to gain less from PSA testing than younger men. Across all ages, routine PSA screening leads to life-saving treatment for cancer in about one in every 1,000 men screened.

Force (USPSTF) guidelines: These independent experts on preventive medicine do not recommend PSA screening for prostate cancer in men at any age, due to a lack of definitive evidence that the benefits of PSA testing are greater than the risks.

"Several large studies asked whether PSA screening of men with no urinary symptoms would save lives, but people don't want to believe the answers that came from these studies," says Dr. Marc B. Garnick, a prostate cancer specialist at Harvard-affiliated Beth Israel Deaconess Medical Center and Editor in Chief of the Harvard Medical School Annual Report on Prostate Diseases. "If you want to know whether you have prostate cancer, you should have a PSA test and a biopsy, but that decision is primarily driven by emotion."

What's the harm?

In the tug of war between fear of cancer and faith in science, it's especially important to understand the pros and cons of PSA testing. "Just in case" PSA screening often leads to men being diagnosed with slow-growing tumors that might never have caused them any problems or shortened their lives. Understandably, most men seek treatment anyway, but this may expose them to treatment complications, such as erectile dysfunction and urinary difficulties. In men at average risk, the harms of PSA testing often outweigh the benefits.

American Urological Association (AUA) age guidelines: The AUA does not recommend routine PSA screening for men 70 or older or with a life expectancy of less than 10 to 15 years. Screening may be considered in men ages 55 to 69 with the knowledge that it will prevent about one cancer death for every 1,000 men screened.

Expert guidelines don't recommend PSA screening in men 70 and older. Because of their more limited lifespan, these men are less likely to benefit from early detection of low-risk cancer. One reason is that there may be simply less time for the condition to become life threatening in most men. "You're facing other competing causes of death, and the likely benefit from treating the prostate cancer—which itself could cause medical problems or even death—is going to be offset by the risk of dying from a medical illnesses such as heart attack, stroke, diabetes, or even another cancer," Dr. Garnick says.

American Cancer Society (ACS) age guidelines: The ACS does not recommend PSA testing for men with no symptoms who are not expected to live more than 10 years (because of age or poor health).

Having a chronic health condition also reduces the potential benefit of early diagnosis and treatment even further, since it tends to shorten lifespan. In contrast, an exceptionally healthy man in his 70s may choose to keep having PSA tests, betting on a longer life-span that provides more time to benefit from early detection. "But even in this case, there is no proof that the benefit of that screening outweighs the harms," Dr. Garnick adds.

Playing the odds

Unfortunately, it's not possible to predict reliably if and when an individual's low-risk cancer could progress to a dangerous stage, although researchers are working hard to change that. In the end, your decision will be personal—and perhaps even a little emotional. What is your overall level of concern about cancer? Are you willing to risk the side effects that sometimes result from treatment, such as impotence and incontinence? How healthy are you, and what is a reasonable estimate of your lifespan? Whatever it turns out to be, you wouldn't want to spend those years sick or disabled from unnecessary treatment.