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Published on: November 3, 2013
PSA screening among elderly men with limited life expectancies
Louise C Walter1, Daniel Bertenthal, Karla Lindquist
1Division of Geriatrics, San Francisco VA Medical Center, California, San Francisco 94121, USA. louise.walter@ucsf.edu
JAMA
|November 16, 2006
Summary
Prostate-specific antigen (PSA) screening is common in elderly men, even those with limited life expectancy. Current screening practices for older men, particularly veterans, do not adequately consider prognosis, leading to potential harm.
Area of Science:
- Geriatric Medicine
- Urology
- Public Health
Background:
- Guidelines often discourage prostate-specific antigen (PSA) screening in elderly men due to potential harms outweighing benefits.
- Limited large-scale data exists on actual PSA screening practices in elderly men relative to their life expectancy.
Purpose of the Study:
- To assess the prevalence of PSA screening among elderly men, specifically including those with limited life expectancies.
- To characterize PSA screening patterns in relation to age and health status in older veterans.
Main Methods:
- A cohort study analyzed 597,642 male veterans aged 70+ from 104 US Department of Veterans Affairs facilities (2002-2003).
- Men were stratified by Charlson comorbidity scores (0 = best health, ≥4 = worst health).
- PSA testing data was obtained from VA records and Medicare claims for 2003.
Main Results:
- In 2003, 56% of elderly men received PSA testing.
- Screening rates decreased with age but did not significantly decline with worsening health within age groups.
- Among men 85+, 34% in best health and 36% in worst health were screened; nonclinical factors influenced screening more than health status.
Conclusions:
- PSA screening rates in elderly veterans with limited life expectancies are higher than recommended, considering the known harms.
- Prognosis requires greater consideration in PSA screening recommendations for elderly men.
- Current screening practices may lead to unnecessary interventions and associated risks.
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