Doctors Referring Prostate Cancer Screening in Older Men

Prostate cancer PSA testing rate varied among primary care physicians

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Prostate cancer screening using the prostate-specific antigen (PSA) blood test is generally not recommended for men over the age of 75. But this recommendation doesn’t seem to be taking hold in practice. Men in their seventh and eighth decades are still having PSA tests.

A recent study uncovered a large variance in PSA screening ordered by primary care doctors.

The authors of this study suggested that additional research is needed to learn why doctors are continuing to order PSA screenings for older men.

"Talk to your doctor about when to get cancer screenings."

Elizabeth Jaramillo, MD, of the University of Texas Medical Branch in Galveston, TX, and colleagues looked at trends in PSA tests ordered by primary care physicians.

These researchers used Texas Medicare data to identify and select 1,963 primary care physicians who had at least 20 male patients with no history of prostate cancer who were 75 years or older.

PSA screening data was analyzed for 61,351 patients. The researchers looked at the men who had PSA testing ordered by any physician and tests ordered by the patients' primary care physicians.

The researchers found that 41.7 percent of all the participants had PSA screenings, and their primary care physicians ordered PSA screens for 28.8 percent of them. Screening rates declined with age.

Among men in their 70s, 34.8 percent underwent PSA screenings ordered by their primary care doctors.

Of the participants between the ages of 80 and 84, 27.4 percent had PSA tests ordered by their primary care physician, as did 18.7 percent of men aged 85 or older.

On average, the physicians referred about half of their patients over the age of 75 for PSA testing. Nearly a quarter of the physicians referred significantly more than half of their older patients for testing, while 16 percent of the doctors referred an average of only 6 percent of their patients who were 75 years of age and older for PSA tests.

After dividing the physicians into 10 different groups, the researchers found a 10-fold difference in the rates of PSA screening between the highest and the lowest groups.

“There are several reasons why PSA screening occurs in the older age group,” E. David Crawford, MD, professor of surgery, urology and radiation oncology and head of the Section of Urologic Oncology at the University of Colorado Health Sciences Center in Denver, told dailyRx News.

“The first is that there is not universal acceptance of the US Preventive Services Task Force (USPSTF) recommendations against screening. Men are living longer, and an 85-year-old man who has a high grade and aggressive cancer may benefit from early detection and treatment. Next, many physicians associate PSA with screening for prostate cancer, but in fact it is also a surrogate for prostate size more commonly than cancer,” said Dr. Crawford, who was not involved in this study.

Findings from this study were published in the October 16 issue of JAMA (The Journal of the American Medical Association).

This research was supported by Comparative Effectiveness Research on Cancer in Texas. It was funded by The Cancer Prevention Research Institute of Texas, the National Institutes of Health, the Agency for Healthcare Research and Quality and University of Texas Medical Branch Clinical and Translational Science Award.

No conflicts of interest were reported.

Review Date: 
October 15, 2013
Last Updated:
October 15, 2013