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Clinical Research

The impact of PSA testing frequency on prostate cancer incidence and treatment in older men

Prostate Cancer and Prostatic Diseases volume 14, pages 332–339 (2011)Cite this article

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Abstract

To quantify the downstream impact of PSA testing on cancer characteristics and utilization of cancer therapies among men aged 70 or older, we utilized patients diagnosed with prostate cancer in 2004–2005 in the Surveillance, Epidemiology and End Results (SEER)-Medicare and their Medicare claims before their cancer diagnosis during 2000–2005. Among men in the highest testing group (4–6 PSA tests), 75% were diagnosed with low- or intermediate-risk of disease, but 77% received treatments within 180 days of cancer diagnosis. More than 45% of newly diagnosed patients in 2004–2005 had 4–6 PSA tests before their cancer diagnosis during 2000–2005. Men in the high testing group were 3.57 times more likely to receive cancer treatments (either surgery, radiation or hormonal therapy) when compared with men who had no previous PSA testing during the same time period. Among men aged 75+ diagnosed with low-risk cancer, men in the high testing group were 78% more likely to receive treatment than those who had no previous PSA testing. In conclusion, given the lack of evidence of effective treatment for elderly patients diagnosed with low- and intermediate-risk prostate cancer and our inability to distinguish indolent from aggressive cancer, more frequent PSA testing among elderly population may exacerbate the risk of overdiagnosis and overtreatment.

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Acknowledgements

The study was supported by the following grants and awards: National Cancer Institute grant # RO1 CA 116399, Cancer Institute of New Jersey core grant NCI CA-72720-10 and Robert Wood Johnson foundation grant # 60624.

Authorship/disclaimer

All authors had access to the data and a role in writing the manuscript. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The content of the information does not reflect the position or policy of the Government or the employers, and no official endorsement should be inferred. The funding source had no role in the design, conduct, or analysis of this study or in the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. The Cancer Institute of New Jersey, New Brunswick, NJ, USA

    Y-H Shao, W Shih & G L Lu-Yao

  2. Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Y-H Shao & G L Lu-Yao

  3. Division of Urology, University of Connecticut Health Center, Farmington, CT, USA

    P C Albertsen

  4. Department of Biostatistics, The School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, USA

    W Shih

  5. State University of New York Downstate Medical Center, Brooklyn, NY, USA

    C B Roberts

  6. The Dean and Betty Gallo Prostate Cancer Center, New Brunswick, NJ, USA

    G L Lu-Yao

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  1. Y-H Shao
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Correspondence to G L Lu-Yao.

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Shao, YH., Albertsen, P., Shih, W. et al. The impact of PSA testing frequency on prostate cancer incidence and treatment in older men. Prostate Cancer Prostatic Dis 14, 332–339 (2011). https://doi.org/10.1038/pcan.2011.29

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