Enough is Enough of Prostate-Specific-Antigen
Testing Once Men Reach Age 75
PSA test has decreased prostate cancer deaths but
other problems more likely to kill elderly
Feb. 23, 2009 - Although widespread
Prostate-Specific-Antigen (PSA) testing has undoubtedly decreased
prostate cancer mortality, there appears to be a point of diminishing
returns? In a study published in the April 2009 issue of The Journal
of Urology, researchers found that in a subgroup of elderly men,
among those who were 75 years old or older and had a PSA below 3 ng/ml (nanograms
per milliliter), none subsequently died of prostate cancer.
One of first studies to focus on senior citizens and
ICDs finds older people are good candidates for ICDs to prevent death
from arrhythmias; but benefit diminishes when age combined with multiple
disease conditions
Sarcosine is better indicator of advancing disease
than traditional prostate specific antigen test (PSA); it is detected in
urine, researchers hopeful simple urine test can be used
The discontinuation of routine PSA screening in
these men may not increase the rates of undetected lethal disease, and
could avoid potentially unnecessary treatments and reduce diagnostic
costs.
Because PSA screening can find cancers that may
become life-threatening in 5 to 25 years, there has been increased usage
of the test in 40 to 50-year-olds. But the test can also discover
cancers that never become life-threatening, perhaps in up to 30% of the
cases. Many men who are older than 75 undergo continued PSA screening,
potentially leading to unnecessary treatment since death from other
causes is more likely than death from prostate cancer.
The study conducted by investigators from the
Baltimore Longitudinal Study of Aging (National Institute on Aging,
National Institutes of Health) and the Department of Urology at Johns
Hopkins School of Medicine involved 849 men (122 with and 727 without
prostate cancer) with serial PSA measurements .
Prostate Cancer
The prostate is the gland below a man's
bladder that produces fluid for semen. Prostate cancer is the
third most common cause of death from cancer in men of all ages.
It is rare in men younger than 40.
Levels of a substance called prostate
specific antigen (PSA) is often high in men with prostate
cancer. However, PSA can also be high with other
prostate conditions. Since the PSA test became common, most
prostate cancers are found before they cause symptoms. Symptoms
of prostate cancer may include
>> Problems passing urine, such as pain,
difficulty starting or stopping the stream, or dribbling
>> Low back pain
>> Pain with ejaculation
Prostate cancer treatment often depends
on the stage of the cancer. How fast the cancer grows and how
different it is from surrounding tissue helps determine the
stage. Treatment may include surgery, radiation therapy,
chemotherapy or control of hormones that affect the cancer.
Researchers found that for men over 75 with PSA
<3ng/ml, none died of prostate cancer and only one developed high-risk
prostate cancer. In contrast, men of all ages with a PSA ≥3.0 ng/ml had
a continually rising probability of death from prostate cancer.
The optimal approach to prostate cancer screening
remains controversial. To date, there is limited evidence from which to
inform the decision on when to discontinue prostate cancer screening,
according to Edware M. Schaeffer, MD, PhD., an author of the report.
Our findings suggest that men at an age of 75-80
years who have a PSA level below 3ng/ml are unlikely to be diagnosed
with a high risk prostate cancer during life.
These men may therefore represent an ideal target
group for discontinuation of PSA testing, which could dramatically
reduce the costs associated with screening and the potential morbidity
of additional evaluations and/or treatment in a population unlikely to
gain benefit.
Dr. Schaeffer emphasized that these findings need
to be confirmed in a much larger study, and that men over the age of 75
years should continue to be monitored for development of clinical signs
of prostate cancer.
Source:
The article is Prostate Specific Antigen Testing
Among the Elderly: When To Stop? by Edward M. Schaeffer MD, PhD, H.
Ballentine Carter MD, Anna Kettermann MA, Stacy Loeb MD, Luigi Ferrucci
MD, PhD, Patricia Landis BS, Bruce J. Trock PhD, and E. Jeffrey Metter
MD. It appears in The Journal of Urology, Volume 181, Issue 4 (April
2009) published by Elsevier.
Keep up with the latest news for senior citizens, baby
boomers
Feb. 23, 2009 - Although widespread
Prostate-Specific-Antigen (PSA) testing has undoubtedly decreased
prostate cancer mortality, there appears to be a point of diminishing
returns? In a study published in the April 2009 issue of The Journal
of Urology, researchers found that in a subgroup of elderly men,
among those who were 75 years old or older and had a PSA below 3 ng/ml (nanograms
per milliliter), none subsequently died of prostate cancer. 
