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Almost a third of older men with limited life expectancy continue to have unnecessary PSA tests. "Excessive screening for prostate cancer in elderly men who have limited life expectancies in the U.S. results in unnecessary anxiety, diagnoses, overtreatment, treatment-related morbidity, and healthcare expenditures without meaningful clinical benefit," the investigators concluded. I suggest that the merits and limitations of PSA should be discussed with patients considering prostate cancer screening, particularly in older men and in those with short estimated life expectancies. Deciding when to stop PSA testing constitutes a major part of the screening controversy. The American Urological Association and the American Cancer Society recommend screening for men who have an estimated life expectancy of at least 10 years, the authors noted. So what advice do I have for men over age 70? If you are active, exercise regularly, have normal blood pressure and no other significant co-morbid conditions like diabetes, heart disease, or other cancers, then you should consider a PSA test every year or every other year. However, if you have high blood pressure, heart disease or diabetes and your life expectancy is less than 10 years, then you will probably die WITH prostate cancer and not from prostate cancer. In the latter situation, it is not necessary to have annual PSA testing. |
