Many older men still getting PSA test for prostate cancer, against recommendations

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Many doctors still give their patients who are 75 and older prostate-specific antigen (PSA) tests for prostate cancer, even though many medical groups have recommended against it.

A research letter published in the Journal of the American Medical Association on Oct. 16 reveals that about 41 percent of men in that age group had the PSA procedure done -- and 29 percent had been recommended for the test by their primary care physician.

"Our results suggest that a major reason for the continued high PSA rate is decision-making by the physicians," senior author Dr. James Goodwin, director of UTMB's Sealy Center on Aging, said in a press release. "That's why there was so much variation among physicians, after accounting for differences among patients. It is clear that some of the overuse is because of preferences of individual patients, but the conclusion of our results is that much more is coming from their primary care physicians."

PSA screening looks for high levels of prostate-specific antigen in the blood, which may signify that the man has prostate cancer.

Researchers looked at Medicare Part A and Part B data from 1,963 Texas physicians who had at least 20 male patients age 75 or older and who saw the patient three or more times during 2009. In total, 61,351 patient records were included in the study.

The particular primary care physician a patient had played a significantly larger role in the likelihood they would have a PSA test, compared to other factors like the patient's age, ethnicity and location.

In May 2012, the U.S. Preventative Services Task Force (USPSTF), an advisory board of medical experts that makes recommendations to the government, said that healthy men regardless of age should not get screened with a PSA test.

After reviewing the research, USPSTF concluded that the tests pick up too many tumors that are so slow growing that they don't really pose a threat to healthy men. These men may go through unnecessary prostate cancer treatments, which can include radiation and surgery that can lead to erectile dysfunction, incontinence, and even a risk of death.

A 13-year study by the National Cancer Institute in 2012 also showed that men who underwent annual PSA screenings had the same death rate from prostate cancer as men who did not take the test each year.

The American Urological Association partially agreed with the USPSTF findings, recommending in May that men under 55 should not get routinely screened with a PSA test, and neither should those over 80, who have a life expectancy of less than 10 to 15 years. The association said that men between the ages of 55 and 69 may benefit from the test, but they should discuss whether a PSA test is the right choice for them with their doctor.

Not everyone agrees that the PSA tests are unnecessary. Dr. Deepak Kapoor, chairman and chief executive of Integrated Medical Professionals, which includes the nation's largest urology practice, told the New York Times that "We will not allow patients to die, which is what will happen if this (USPSTF) recommendation is accepted."

A study in March 2012 showed that men routinely screed with PSA tests were 30 percent less likely to die from prostate cancer. However, the authors noted that the tests had no effect on "all-cause mortality," meaning the men were likely to die at around same age from another cause regardless if they took the test.

However, the JAMA research letter authors are adamant that PSA testing for the older age group is futile. They called for more studies to see why some doctors were recommending PSA tests more than others.

"Overtesting can create harms, including overdiagnosis," lead author Dr. Elizabeth Jaramillo, lead author and an instructor of internal medicine-geriatrics at UTMB, said in a press release. "The vast majority of prostate cancers are so slow growing that an elderly man is much more likely to die of another condition in his lifetime than from the cancer."

Dr. Anthony D'Amico, chief of radiation oncology at Brigham and Women's Hospital in Boston, said he believed the test should be based on the man's health and life expectancy, not on an age recommendation.

"My personal opinion is in men over the age of 75 who are healthy, particularly those at high risk, it's very reasonable," D'Amico, who was not involved in the study, said to HealthDay.

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