Prostate Cancer Screening: When Can It Stop?

Is screening for prostate cancer really beneficial for older men? New findings may suggest not.

Regular tests and screening for any type of cancer may seem like a no-brainer, especially when you are at an age where the risk for developing cancer is increased.

But for men age 75 and older, is regular prostate cancer screening really a benefit?

Prostate Cancer Screening in Older Men: New Findings
The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for breast, colorectal, and prostate cancer at age 75 and beyond. Recently, however, a study from the University of Connecticut in Storrs, published in the Archives of Internal Medicine, found that more than half of men between 75 and 79, and 42 percent of men over 80 have undergone prostate cancer screening. Experts say testing at this age has no real benefit — and in fact may even be harmful. The reasons?

• Risks of the screening test.Recently, the USPSTF advised against routine use of the prostate-specific antigen (PSA) test, even in younger men, because although it’s the best option we currently have for detecting prostate cancer, it can often result in false positives and overtreatment, which may be even more devastating to the man than the cancer itself.
• Follow-up from a positive PSA test. If a PSA test reads positive — even if it is a false positive — invasive and expensive tests may have to be done to confirm or rule out a prostate cancer diagnosis.
• Anxiety over a false-positive result. The fear caused by thinking that you may have prostate cancer can cause physical and emotional harm, especially in older men.
• Life expectancy. Prostate cancer is often, but not always, a slow-growing cancer. Men who have a life expectancy of less than 10 years may not experience any symptoms or ill effects of their prostate cancer before they die of another cause.
• Side effects of treatments.The treatments for prostate cancer can have a number of side effects — including incontinence and erectile dysfunction, which can affect quality of life for years after treatment is completed. For an older man with a short life expectancy and a slow-growing prostate tumor, radiation, surgery, and hormone therapy may do more harm than good.

Should Older Men be Screened for Prostate Cancer?

The American Cancer Society and other organizations recommend that men make a decision about prostate cancer screening with their doctors, taking into consideration their personal risk factors and preferences. This discussion should happen at around age 50 for men at average risk and at 45 for men at high risk (including those with a family history of prostate cancer or other risk factors and men who are African-American). It’s also important to keep in mind that while many prostate cancer tumors grow slowly, not all do.

The authors of the Connecticut study echoed the ACS recommendations. “Screening decisions should be individualized based on life expectancy, health status, an informed discussion with the patient about the potential harms and benefits, and patient values and preferences,” said lead author Keith Belliszi, an assistant professor of human development and family studies.

“Prostate cancer is often a slow-growing disease, and if men have other health problems that are likely to limit their life, then finding early prostate cancer and treating that disease might end up doing them more harm than good,” says Durado Brooks, MD, director of prostate and colorectal cancer at the American Cancer Society.

“If it’s not expected that you will live for another 10 years based on your overall health status, then the likelihood that it will benefit you is actually pretty low. In most instances, prostate cancer grows very slowly. Conversely, for the very active, fit 75-year-old who has non-significant health problems [and who can] reasonably expect to live well into their 80s, then finding [and treating] prostate cancer may end up benefiting them,” Dr. Brooks says.

Brooks says it’s important to note that the task force is recommending against screening for men in that age group, not against having diagnostic testing for men in that age group who are experiencing symptoms.

“If a man shows symptoms, then it is reasonable to do PSA testing and a digital rectal exam to determine whether or not cancer is the cause for those symptoms. The distinction between screening and diagnostic testing often gets overlooked,” says Brooks.

Remember, just because you’re over 75 doesn’t mean that you’re not in good health and don’t have many more great years ahead. Says Brooks, “Each man in that age group needs to have a frank discussion with his physician about his overall health status.” Consulting with your doctor is the best way to determine if prostate cancer screening at your age will be beneficial for you.