Task force says no to PSA screening for older men

Nancy Ferrari

Senior editor, Harvard Health

Screening for prostate cancer leads to so much anxiety — and so many unnecessary biopsies, surgeries, and complications — that doctors should stop testing men who are 75 or older, according to a new recommendation from the U.S. Preventive Services Task Force announced in August 2008. The panel also concluded that the benefit of screening in younger men is uncertain.

In the United States, more than 218,000 men are diagnosed with prostate cancer and about 28,000 die of it each year. Physicians most often screen for the disease with blood tests to check for prostate-specific antigen (PSA) and digital rectal exams; of the two, the PSA test is more likely to detect prostate cancer, especially during early stages of development. Men with an elevated PSA may then have a biopsy and, depending on the results, undergo treatment. Complications often result, including urinary incontinence and impotence.

However, cancers discovered through PSA testing take years to affect health, and those that are serious enough to kill take more than a decade to do so. Because a 75-year-old man has an average life expectancy of about 10 years and is more likely to die from other causes, such as heart disease or stroke, prostate screening is unlikely to help men who are 75 or older to live longer, the panel determined. Men younger than 75 with chronic medical problems and a life expectancy of less than 10 years are also unlikely to benefit from screening, according to the task force.

The panel did not find enough evidence to assess whether the benefits of PSA testing outweigh the risks in younger, healthy men. Instead, the panel encouraged men to talk with their doctor about the potential benefits and possible harms of getting the PSA test before they opt for screening.

The U.S. Preventive Services Task Force is the first group to define an explicit age above which screening is likely to be ineffective or harmful. The results of two ongoing trials — the National Cancer Institute’s Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial and the European Randomized Study of Screening for Prostate Cancer — should help to clarify the potential benefits of screening in men under the age of 75.*

SOURCE: Lin K, Lipsitz R, Miller T, Janakiraman S. Benefits and Harms of Prostate-Specific Antigen Screening for Prostate Cancer: An Evidence Update for the U.S. Preventive Services Task Force. Annals of Internal Medicine 2008;149:192–99. PMID: 18678846.

Originally published April 2009; last reviewed March 21, 2011.

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