Researchers from Duke University have concluded that 78% of men 75 years of age or older disagree with the recommendations of the U.S. Preventative Task Force (USPSTF) to not screen with prostate-specific antigen (PSA) for prostate cancer. They also pointed out that men aged >/= 75 years had higher risk disease and poorer survival than younger men. The details of this study were published early online in Urology on October 6, 2009.[1]

Prostate cancer is the second leading cause of cancer death in the United States. PSA testing is becoming routine after the age of 50-55, despite the fact that early diagnosis has not been clearly shown to improve survival. In 2007 the USPSTF did not make recommendations for or against PSA testing for men 75 years of age or younger, but they did recommend no PSA testing in men over the age of 75 years.

These authors surveyed 340 men in the Duke screening clinic and found that 78% disagreed with the USPSTF recommendations. Awareness of the guidelines did not affect the results of this survey. Awareness of the guidelines was associated with education level. These researchers also looked at a cohort of 4,196 men who underwent radical prostatectomy between 1988 and 2008; these men were stratified by age into three groups: <65, 65-74, and >75 years. Age >75 was predictive of high-risk disease with a higher rate of PSA recurrence, distant metastases, and disease-specific death compared with younger patients. These authors concluded: “The USPSTF recommendation was supported neither by public opinion nor disease risk and survival results.”

Comments: These data would suggest than men over the age of 75 could potentially benefit from PSA screening to detect early disease because they tend to have more aggressive disease at diagnosis. These data also show that regular PSA screening is probably endorsed by the majority of males in the United States.

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