Regular prostate-specific antigen screening may be discontinued in certain elderly populations
May 15, 2008
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It is well known that prostate cancer screening is an important part of health maintenance and is very effective in detecting the disease at its most treatable stages in men who are regularly screened. However, prostate cancer can be slow growing and is not always aggressive enough to require immediate treatment. In older patients with shorter life expectancies, a non-aggressive, screen-detected cancer can result in increased stress and, possibly, unnecessary treatment. Researchers sought to determine a safe cut off for annual screening of older men based on PSA levels and an individual’s probability of developing deadly prostate cancer in their remaining life.
Using a cohort of 849 participants in the Baltimore Longitudinal Study of Aging – 122 with prostate cancer and 727 men without the disease – Johns Hopkins researchers examined the proportion of men with aggressive prostate cancer by PSA and age to evaluate the safety of discontinuing PSA testing among older men. Study participants were aged 75-80 and were divided into two groups by PSA (3 ng/ml or above, and below 3 ng/ml).
Researchers compared multiple outcomes: probability of death from prostate cancer, death from prostate cancer, Gleason score 8 or above at diagnosis or PSA 20 ng/ml or above at diagnosis. Participants who presented with a PSA of at least 3 ng/ml had an increasing probability of death from prostate cancer, while men in the same age group with a PSA below 3 ng/ml did not share this risk. From these results, researchers conclude that it may be safe to discontinue regular testing in men ages 75-80 with PSA levels below 3 ng/ml as they are unlikely to develop aggressive disease during their remaining life.
Source: American Urological Association
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