PSA Test Outcomes Vary for Older Men

Prostate cancer diagnostic testing and treatment higher in older men undergoing PSA testing

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) While the incidence of prostate cancer is greater in older men, the screening guidelines are murky. A new study analyzed what happened after older men were screened. 

Researchers recently looked at the outcomes of older men who underwent PSA screenings.

About one third of the men aged 65 and older who had PSA (prostate-specific antigen) tests were found to have elevated levels of more than 4.0 ng/mL.

And about half of those men were eventually diagnosed with and treated for prostate cancer.

"Discuss your prostate cancer risks with a doctor."

Louise C. Walter, MD, of Division of Geriatrics at the San Francisco VA Medical Center, led the study thatfollowed nearly 300,000 men 65 years of age and older who underwent PSA screening in 2003 and were followed for five years.

Just over 25,000 men (8.5 percent) had PSA levels of greater than 4.0 ng/mL. During the following five years, 8,313 men (33 percent) had at least one prostate biopsy.

Of these men, nearly 63 percent (5,220 men) were diagnosed with prostate cancer, and 82 percent (4,284) of those were treated for the disease.

The researchers also found that 468 men (5.6 percent) had complications within seven days after prostate biopsy.

Among those who were treated, about 600 men developed urinary incontinence, and nearly 600 experienced erectile dysfunction

While the number of prostate biopsies declined as the men got older and had other serious conditions (comorbidities), treatment exceeded 75 percent among men 85 years and older who had cancers that were detected by biopsies.

"This is an interesting study of PSA practice patterns 10 years ago within the Veterans Administration Hospital System in the United States. At that time, PSA screening was of unquestioned value and was routinely done," urologist Brian Miles, MD, FACS, told dailyRx News. 

"Now, 10 years later, diagnosis and treatment patterns have changed so that I believe more men would be on active surveillance and true screening of men over age 75 or 80 would be unusual unless the patient had physical findings or x-ray or laboratory findings that made pursuing the diagnosis of prostate cancer prudent and appropriate," said Dr. Miles, who specializes in robotic radical retropubic prostatectomy at Methodist Hospital in Houston.

"The study, I think, validates that judgment that is used and will continue to be used in the diagnosis and treatment of prostate cancer and that as our knowledge of the best use of PSA and other tests for 'screening' for prostate cancer improves, so will our ability to identify patients truly needing therapy," he said.

This study, which was published April 15 in JAMA Internal Medicine, was supported by the National Cancer Institute, National Institute on Aging, Veterans Affairs Career Development Award Program, and the New Mexico Veterans Affairs Health Care System. No conflicts of interest were disclosed.

Reviewed by: 
Review Date: 
April 15, 2013
Last Updated:
December 18, 2013