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Should men over the age of 65 years receive PSA screening? Argument against

Nature Clinical Practice Urology volume 5, pages 232–233 (2008)Cite this article

In a US study published in JAMA in 2006, Walters et al.1 reported that 56% of men over the age of 70 years, who had no previous history or symptoms of prostate cancer, were screened for prostate cancer with a serum PSA test. Among men over the age of 85 years, 34% of the men in good health and 36% of the men in poor health received a PSA test. Does this testing make any sense from a public health perspective? To address this question, policy analysts frequently pose five key questions: Is the disease a substantial health problem among those being tested? Is the test accurate? Will the test improve the patients' outcomes? Will the test cause patients any harm? And will the screening test do more harm than good?

Firstly, prostate cancer is common among American men, and it is the second leading cause of cancer death after lung cancer in the US, accounting for 9% of cancer-related deaths. The lifetime risk of prostate cancer death is 2.2%.2 Partly because of widespread PSA testing in contemporary medical practice, most men destined to have clinically significant disease are diagnosed before the age of 65 years. PSA testing is associated with a long lead time before prostate cancer becomes clinically significant, and men with an abnormal serum PSA level at the age of 64 years are unlikely to present with clinically significant disease much before the age of 70–75 years. Most men diagnosed with prostate cancer in their mid-seventies will have satisfactory outcomes with androgen deprivation therapy (ADT). Unfortunately, men with poorly differentiated disease who have a short duration of response to ADT are also unlikely to be cured by surgery or radiation therapy.

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References

  1. Walter LC et al. (2006) PSA screening among elderly men with limited life expectancies. JAMA 296: 2336–2342

    Article  CAS  Google Scholar 

  2. American Cancer Society Statistics for 2007 [http://www.cancer.org/docroot/stt/stt_0.asp] (accessed 21 February 2008)

  3. Johansson JE et al. (2004) Natural history of early, localized prostate cancer. JAMA 291: 2713–2719

    Article  CAS  Google Scholar 

  4. Albertsen PC et al. (2005) 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA 293: 2095–2101

    Article  CAS  Google Scholar 

  5. Albertsen PC et al. (2005) Prostate cancer and the Will Rogers phenomenon. J Natl Cancer Inst 97: 1248–1253

    Article  Google Scholar 

  6. Bill-Axelson A et al. (2005) Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 352: 1977–1984

    Article  CAS  Google Scholar 

  7. Draisma G et al. (2003) Lead times and overdetection due to prostate-specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst 95: 868–878

    Article  Google Scholar 

  8. Stanford JL et al. (2000) Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA 283: 354–360

    Article  CAS  Google Scholar 

  9. Hamilton AS et al. (2001) Health outcomes after external-beam radiation therapy for clinically localized prostate cancer: results from the Prostate Cancer Outcomes Study. J Clin Oncol 19: 2517–2526

    Article  CAS  Google Scholar 

  10. de Koning HJ et al. (2002) Large-scale randomized prostate cancer screening trials: program performances in the European Randomized Screening for Prostate Cancer trial and the Prostate, Lung, Colorectal and Ovary cancer trial. Int J Cancer 97: 237–244

    Article  CAS  Google Scholar 

  11. Gohagan JK et al. (2000) The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial of the National Cancer Institute: history, organization, and status. Control Clin Trials 21 (Suppl 6): 251S–272S

    Article  CAS  Google Scholar 

Download references

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  1. University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA albertsen@nso.uchc.edu

Authors and Affiliations

  1. PC Albertsen is a Professor and Chief of the Division of Urology, University of Connecticut Health Center, Farmington, CT, USA.,

    Peter C Albertsen

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  1. Peter C Albertsen
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Albertsen, P. Should men over the age of 65 years receive PSA screening? Argument against. Nat Rev Urol 5, 232–233 (2008). https://doi.org/10.1038/ncpuro1079

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