"No Need for PSA Testing after Age 75"

The relevance of the prostate specific antigen (PSA ) test for cancer of the prostate has been a matter of controversy, in recent years. Now there’s a new proposal – men over 75 without prostate disease need not bother to have the test. Why is this? The proposal comes from the US Preventive Services task force, which has published its recommendations in the Annals of Internal Medicine. Behind it is the realization that most prostate cancer grows extremely slowly, and many men die of something else before the cancer causes a problem.

While there’s convincing evidence that PSA screening can detect some cases of prostrate cancer, there isn’t any good evidence that finding a cancer by PSA testing produces a better overall outcome than when diagnosis is made by biopsy after a suspicious digital rectal examination, for example. They suggest, therefore, that PSA screening in men under 75 should be based on a discussion between the patient and his doctor.

In men over 75, the task force found evidence that any additional benefits of treatment of prostate cancer found by PSA testing are small to none. On the other hand, there can be substantial harm from such treatment – erectile dysfunction, urinary incontinence, bowel upset, and death. Minor harm consists of pain and discomfort of a prostate biopsy, and anxiety associated with a positive PSA result, whether it’s a true result or a ‘false-positive’.

The task force concludes that “there is moderate certainty that [for men 75 years or older] the harms of screening for prostate cancer outweigh the benefits”. If you want to have help about making a decision as to having a PSA or not, go to the Center for Disease Control website, here.