A study of almost 600,000 men aged 70 and older reveals that 56 percent had a routine prostate-specific antigen (PSA) screening, a blood test for prostate cancer, even though no treatment guidelines recommend PSA screening for men of that age.
Screening rates declined with age, but overall health had little or no impact on whether a PSA test was performed.
In fact, says lead author Louise C. Walter, MD, a staff physician at the San Francisco VA Medical Center, health status had so little bearing on the decision to screen that 36 percent of men age 85 and older who were in poor health and at high risk of dying within a year were given the test.
"Not a single professional organization, physicians' group, or prostate cancer advocacy group advocates PSA screening for frail, elderly men, and yet we are doing it," says Walter, who is also an assistant professor of medicine at the University of California, San Francisco.
The study appears in the November 15, 2006 issue of the Journal of the American Medical Association.
In general, performing the PSA test on men 70 and older is a poor idea for a number of reasons, Walter says. "First, as you grow older, there's good evidence that PSA becomes less accurate. Second, not all prostate cancers are alike." The PSA test is best at detecting slow-growing cancers that will have a health impact 10 to 15 years after they are found, Walter explains, while it tends to miss aggressive, fast-growing cancers. "Third, it's been well-documented that older men, particularly those with chronic or severe illnesses, have more complications from all types of prostate cancer treatment than younger men." Finally, says Walter, even if no treatment is performed, simply the knowledge of an elevated PSA causes anxiety and thus has a negative impact on quality of life.
"This is why no guideline recommends PSA screening for men who, taking health status as well as age into account, have a life expectancy of 10 years or less," concludes Walter.
The study authors examined the medical records of 597,642 men seen at 104 VA facilities during 2002 and 2003. They excluded men with prostate symptoms, a history of prostate cancer, or any other medical condition that indicated a need for the test.
The researchers classified the men into four age categories (70-74, 75-79, 80-84, and 85-plus) and three health categories (best, average, and worst) based on the Charlson co-morbidity index, a standard measure of risk of death. The men in the "worst" category were four times more likely to die within one year than men in the "best" category.
Age was the strongest predictor of PSA screening: 64 percent of all men aged 70 to 74 had the test, while 36 percent of all men 85 and older had it. Health status was only a mild predictor: 58 percent of the men in best health were tested versus 51 percent of the men in worst health.
Within each age range, health status made so little difference in who got screened that among men age 85 and older, 36 percent of men in the worst health were screened while only 34 percent of men in the best health were screened. "For these elderly men in very bad health, the PSA test is more of a disservice than it is a help," says Walter. "In fact, it actively takes away from time we should spend helping them with their immediate health problems."
A number of non-clinical factors had greater influence than health status on determining screening, she says. Southerners were more likely to be tested than men in other regions of the country. Married men were more likely to be tested than single men. The higher the income a man had, the more likely he was to be tested. Paradoxically, African-Americans were less likely to be tested, "even though African-Americans are at higher risk for prostate cancer and prostate cancer mortality," says Walter.
The study did not examine the reasons for the high rate of inappropriate testing, or for the influence of non-clinical factors on testing. Walter says that current publicity campaigns urging all men to get screened provide inappropriate, overly simplistic advice. "We need to educate the public more about the downsides of screening tests. As you grow older and develop more and more chronic or severe diseases, those are the things you and your doctor should focus on. This isn't about cost-cutting. It's about not doing harm by not subjecting people to tests and procedures they don't need."
Steve Tokar | EurekAlert!
Win-win strategies for climate and food security
02.10.2017 | International Institute for Applied Systems Analysis (IIASA)
The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft
University of Maryland researchers contribute to historic detection of gravitational waves and light created by event
On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...
Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.
Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....
Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).
When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...
Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.
How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...
Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.
It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...
17.10.2017 | Event News
10.10.2017 | Event News
10.10.2017 | Event News
18.10.2017 | Physics and Astronomy
18.10.2017 | Physics and Astronomy
18.10.2017 | Life Sciences