Prostate screening in elderly men

A new recommendation from the U.S. Preventive Services Task Force (USPSTF) advises against prostate cancer screening for men aged 75 years and older and suggests that clinicians discuss with younger men the pros and cons of prostate-specific antigen (PSA) testing before performing it.

These recommendations are the first to pinpoint an age at which such testing is likely to do the patient more harm than good.

Convincing evidence in the medical literature has shown that PSA screening can detect some cases of prostate cancer. However, “adequate evidence” revealed that “the incremental benefits of treatment…are small to none” for men aged 75 and older and that such testing provided few health benefits but led to substantial physical and psychological harms (Ann Intern Med. 2008;149:185-192, 192-199, I37).

PSA testing is usually done with the assumption that most asymptomatic cases of prostate cancer will become symptomatic and lead to poor outcomes. Yet in cases of slow-growing prostate cancer, symptoms may never occur. And, according to the USPSTF, the length of time required to experience a mortality benefit from treatment is >10 years, but a 75-year-old man is expected to live on average only 10 years longer and is more likely to die from causes other than prostate cancer.
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