Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Elderly, ill men get unneeded prostate cancer screenings

15.11.2006
Health status, life expectancy have little or no impact on whether men 70 and older get PSA

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!
Further information:
http://www.ucsf.edu

More articles from Studies and Analyses:

nachricht New study: How does Europe become a leading player for software and IT services?
03.04.2017 | Fraunhofer-Institut für System- und Innovationsforschung (ISI)

nachricht Reusable carbon nanotubes could be the water filter of the future, says RIT study
30.03.2017 | Rochester Institute of Technology

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Making lightweight construction suitable for series production

More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.

Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...

Im Focus: Wonder material? Novel nanotube structure strengthens thin films for flexible electronics

Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.

"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

7th International Conference on Crystalline Silicon Photovoltaics in Freiburg on April 3-5, 2017

03.04.2017 | Event News

 
Latest News

Bare bones: Making bones transparent

27.04.2017 | Life Sciences

Study offers new theoretical approach to describing non-equilibrium phase transitions

27.04.2017 | Physics and Astronomy

From volcano's slope, NASA instrument looks sky high and to the future

27.04.2017 | Earth Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>