Prostate Screening Tests In Older
Men Decline, But Many Still Get Them, Study Finds
Government panel recommended in
August 2008 that men over age 75 should not be routinely screened for
By Julie Appleby,
CAPSULES: Short Takes On News & Events
Photo by Joe Raedle/Getty Images
March 4, 2013 - Fewer men over age
75 are being routinely screened for cancer with a prostate-specific
antigen (PSA) test following a 2008 recommendation against the tests,
researchers said today, suggesting a less-is-more approach
But while the numbers have
declined, they remain significant more than 4 in 10 men in that group
still get the tests.
When a prestigious government panel
recommended in August 2008 that men over age 75 should not be routinely
screened for prostate cancer, it kicked off controversy as well as
speculation that some doctors and patients would not heed the warning
the tests led to more harm than good.
Theres a lot of skepticism in the
medical community that guidelines dont work, especially when the
guidelines recommend less care, said David Howard, an associate
professor of health policy at Emory University and one of the authors of
the study published in Health Affairs
Howard and researchers from the
Centers for Disease Control and Prevention studied what happened to
screening rates after the recommendation from the U.S. Preventive
Services Task Force. The task force said the testing and resulting
biopsies, surgeries and other treatment was more likely to cause
medical harm than to save lives.
Before the recommendation, 47
percent of men over 75 had a PSA test. By 2010, that percentage dropped
to 42 percent, according to Medicare data. That occurred without any
change in payment policy by Medicare, which continues to cover the PSA
Howard said the results should
prompt optimism about similar efforts to slow the use of unnecessary or
harmful tests, procedures or drugs.
Such testing can lead to other more
invasive procedures, including surgeries, which carry serious risks,
including incontinence and impotence.
Many men are harmed as a result of
prostate cancer screening and few, if any, benefit, the task force
said, prompting sharp disagreement from some urologists and other
doctors, who say routine screening helps them find cases of cancer that
should be treated.
In men under age 75, Howards study
found an uptick in the percentage screened. In 2007 before the
guidelines 49.5 percent of men age 65 to 74 had a PSA test. By 2010,
that percentage had risen to 51.5, which Howard described as
statistically significant. Howard said the researchers could not
pinpoint what led to that increase in the younger age group.
There are still a lot of men who
receive a PSA test, Howard said. But if you buy the preventive
services task force rationale, which not everyone does, then the simple
issuance of a recommendation moved screening rates in the right