Many older men still get prostate cancer testing

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Study raises questions about prostate cancer screening exams

New debate over popular test

Despite recommendations not to screen men age 75 and older for prostate cancer, most elderly men still get tested, according to a new survey.

"I think there is a lot of push from patients to get (the test)," said Dr. Edward Messing from the University of Rochester Medical Center, who worked on the study.

"Eighty-year-olds don't think they're that old anymore, and maybe they're not. They think they still have a life ahead of them."

In 2008, the U.S. Preventive Services Task Force (USPSTF), a federally-funded panel, issued guidelines advising against screening older men for prostate cancer.

"In this age group we have no evidence of benefit. We have ample evidence of harm," said Dr. Michael LeFevre, a co-chair of the task force.

Prostate cancer is common in the elderly. LeFevre said some studies have estimated that as many as half of men over age 75 have the cancer. But it's typically slow-growing, and often doesn't pose a serious threat compared to other chronic conditions.

And in some cases, LeFevre said, biopsies and treatment for prostate cancer can do more damage to men's bodies than the cancer itself.

In weighing the risks and benefits, the USPSTF decided that older men are better off without routine screening.

New draft guidelines not covered in this study argue against routine screening in all men, regardless of age.

To determine whether the 2008 recommendations have had any impact on the number of men who get tested, Messing and his colleagues looked to surveys given before and after the guidelines were released.

In 2006, 9,000 older men responded to questions about whether they had been given a prostate specific antigen (PSA) test, which looks for a protein that is elevated in men who have cancer.

Sixty percent of them reported that they had received a PSA test within the last year, according to findings published in the urology journal BJU International.

That compared to 63 percent of 12,000 men surveyed in 2008 and 60 percent of 14,800 survey participants in 2010 who said they'd had a PSA test.

Messing said the results show not a lot of people are following the USPSTF's recommendations.

"I would say it's a little disappointing," said LeFevre, who didn't participate in the study.

LeFevre said he believes the findings reflect 20 years of public health messages that early detection of cancer saves lives and that screening is important in finding cancers early.

"It's difficult to disrupt established belief systems in both patients and physicians," he told Reuters Health.

The findings jibe with those from another new study released this week in the Journal of the American Medical Association, which found no change in the number of older men who reported a recent PSA test between 2005 and 2010 based on other survey data.

Prostate cancer screening policies have been the topic of much debate. Last fall, the USPSTF came out with new draft guidelines recommending against routine PSA testing in younger men as well, again citing the unfavorable balance of harms and benefits.

The challenge has been trying to find a balance between hunting down and treating a cancer that kills 32,000 men a year and avoiding potentially harmful interventions for the many more who develop slow-growing cancer that might never hurt them.

One recent study found that to prevent one death from prostate cancer, more than 1,000 men would have to be screened (see Reuters Health story of March 14, 2012). That study was done in men ages 55 to 69.

The benefits of screening are thought to be lower in older men because they have a shorter life expectancy. But Messing told Reuters Health he disagrees with a blanket policy against testing elderly men for prostate cancer.

He pointed out that the disease kills older men in greater numbers than younger men -- and screening them might catch those cancers early.

Some men in their 70s and 80s can live another 10 to 20 years, Messing said, and prostate cancer screening decisions should be made based on whether they are likely to live long enough to see the benefits of that screening, rather than solely based on their age.