PSA Screening Among Older Men in Poor Health

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Summary and Comment

PSA Screening Among Older Men in Poor Health

Elders in good health and those in poor health are about equally likely to be screened.

Whether prostate-specific antigen (PSA) testing lowers prostate cancer–associated mortality among otherwise healthy older men is unclear, but it generally is accepted that PSA testing is inappropriate for men with limited (shorter than 10 years) life expectancy. U.S. Veterans Affairs (VA) investigators used a VA database and Medicare claims data to study the use of PSA screening during 2003 in nearly 600,000 male VA patients (median age, 77), who were grouped by chronic disease burden and health status.

Although PSA testing rates were lower in older age groups (64% for men who were 70–74 and 36% for men who were $≥$ 85), minimal differences in testing rates were noted based on health status and chronic disease burden (58% for those in the best health and 51% for those in the worst). Among the oldest men ( $≥$ 85), 34% in good health underwent PSA screening, compared with 36% of those in poor health. In multivariate analysis, marital status and geographic location were stronger predictors of PSA screening than was health status. Unmarried men were less likely than married men to undergo PSA screening; men who lived in the southern U.S. were most likely to be screened.

Comment: In this study, PSA screening was remarkably common in older men with limited life expectancy; in other recent studies, researchers also described aggressive screening and treatment in elders (Journal Watch Sep 14 2006). An editorialist notes that screening decisions appear to be influenced inappropriately by both patients’ and physicians’ overestimation of PSA-testing benefits. Marital status appears to play a significant role as well.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine November 14, 2006