What happens to older men after a screening test for prostate cancer?BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2421 (Published 17 April 2013) Cite this as: BMJ 2013;346:f2421
When US researchers tracked nearly 300 000 older men for five years after a screening test for prostate cancer, they found that among the 8.5% (25 208/295 645) who had a prostate specific antigen (PSA) concentration over 4 µg/L, only a third had a prostate biopsy. But most of those who did have a biopsy were diagnosed with cancer (5220/8313; 63%) and treated (4284/5220; 82%). Biopsy rates fell with advancing age and comorbidity, but once a biopsy was done and a diagnosis made, men were treated even when they were very old or very sick, or when they had low grade cancers. Nearly 60% of men with cancers had a radical prostatectomy or radiotherapy with curative intent. Another quarter had hormone therapy. Just under 14% of treated men developed new incontinence (584/4284). A similar proportion developed erectile dysfunction (588/4284). Both figures are likely to be underestimates, say the authors.
The men in this study were all at least 65 years old when screened in 2003. More than 100 000 were at least 75 years. US national guidance recommended against PSA screening for men over 75 years in 2008 and extended that moratorium to men of all ages in 2012, says a linked editorial (doi:10.1001/jamainternmed.2013.1164). But PSA tests are still done every day, everywhere. If PSA screening does not benefit older men (or any men), we are left with a cascade of harm caused by a low value test that consumes resources that would be better spent on interventions that work. It’s time to start talking seriously about how to divert those resources for good, says the editorial.
Cite this as: BMJ 2013;346:f2421