Many Men Disagree With No-PSA-at-75 Recommendation

Findings also suggest that older patients often have more aggressive disease, worse outcomes
By Eric Metcalf
HealthDay Reporter

THURSDAY, June 3 (HealthDay News) -- A U.S. Preventive Services Task Force (USPSTF) recommendation to discontinue prostate-specific antigen (PSA) screening at age 75 is not supported by many men, and men ages 75 and older show higher-risk disease and poorer survival, according to research published in the May issue of Urology.

Arthur A. Caire, M.D., of the Duke University Medical Center in Durham, N.C., and colleagues analyzed data from a survey of 340 men attending a no-cost PSA screening clinic, as well as a cohort of 4,196 men who underwent radical prostatectomy between 1988 and 2008.

The researchers found that most of the men surveyed were unaware of the USPSTF recommendation to discontinue screening at 75, and 78.2 percent disagreed with it. In their analysis of the men who underwent prostatectomy, they found that being 75 or older predicted high-risk disease based on D'Amico's criteria (odds ratio, 2.72). Being 75 or older was also associated with higher rates of PSA recurrence, distant metastasis, and disease-specific death compared to younger groups.

"With respect to the 2008 USPSTF guideline, not all 75-year-old men are the same. Rather than discontinuing screening based solely [upon] chronologic age, the decision to screen in this population should take into account the absolute PSA level and PSA trends over time, as well as general health status," writes the author of one of the two editorials accompanying the study. In one of two replies, a study author writes that, "if the USPSTF analysis of the issue of PSA testing at or above age 75 is an indication of how the government will evaluate evidence-based medicine to make suggestions or mandates, we will be embarking on interesting times."

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