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PSA Screening Prompts Subsequent Biopsies and Treatment in Older Men

Prostate-specific antigen (PSA) screening among men 65 years and older prompts subsequent biopsies and perhaps unnecessary treatment for some men with prostate cancer, according to an article recently published in the Journal of the American Medical Association, Internal Medicine.

Screening for prostate cancer using PSA levels remains a standard practice in the United States. The screening requires a blood test, and evaluates levels of the PSA protein in the blood.

Prostate-specific antigens are proteins that are found on the surface of some cells of the prostate that are ultimately shed in the blood. If prostate cancer is present, these levels tend to be higher.

Controversy exists surrounding the use of PSA levels for prostate cancer screening for all men, as many prostate cancers are slow-growing, particularly in the elderly. Men with slow-growing prostate cancer are able to live with the disease for long periods of time, often succumbing to medical issues not related to prostate cancer versus the cancer itself. Therefore, treatment for these patients leaves them susceptible to living with the side effects of therapy without extending their survival. Researchers continue to explore the best way in which to integrate PSA testing into treatment for prostate cancer.

Researchers recently conducted a clinical study to help elucidate the long-term consequences of PSA screening among men 65 years or older. The study included 295,645 men in the national Veterans Affairs health care system who underwent PSA screening in 2003. Those with a PSA level of 4.0 ng/mL or higher were followed for 5 years.

8.5% had a PSA level of 4.0 ng/mL or higher.
33% of these men underwent a subsequent prostate biopsy.
Nearly 63% of men who underwent a biopsy were diagnosed with prostate cancer.
82% of men diagnosed with prostate cancer underwent treatment for the cancer.
75% of men 85 years or older diagnosed with prostate cancer underwent treatment for their cancer.
5.6% of men had complications from their biopsy within 7 days of the procedure.
13.6% of men had urinary incontinence and 13.7% experienced erectile dysfunction from their cancer treatment.
The researchers stated that “once cancer is detected on biopsy, most men undergo immediate treatment regardless of advancing age, worsening comorbidity, or low-risk cancer. Understanding downstream outcomes in clinical practice should better inform individualized decisions among older men considering PSA screening.”

Men undergoing PSA screening should speak with their healthcare provider regarding their individual risks and benefits of all subsequent procedures.

Reference: Walter L, Fung K, Kirby K, et al. Five-Year Downstream Outcomes Following Prostate-Specific Antigen Screening in Older Men. Journal of the American Medical Association, Internal Medicine. Published on-line first April 15, 2013. doi:10.1001/jamainternmed.2013.323.