ASCO GU 2008 - Prostate Specific Antigen Screening Among Elderly Men With Limited Life Expectancies

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health
Article Date: 24 Feb 2008 - 0:00 PDT

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UroToday.com - The US population is living longer, and by 2025 there will be more than one million Americans older than age 100. In screening the elderly man, we know that the incidence of high risk CaP increases with age. Dr. Konety cited the CaPSURE database, where the incidence of high risk CaP increases from 22% to 43% in men under and over age 75 years, respectively. 36% of men over age 85 continue to get PSA screening. Dr. Konety cited 7 legal cases of men dying from CaP who argued that they should have been screened. 53% of physicians who screened did so due to a concern over legal ramifications. In addition, many states mandate insurance coverage for PSA screening.

Reasons not to screen elderly men include a 56% over-detection rate in men over 75 years. With an increase in age, there is a decrease in the number of men undergoing when under the care of a urologist, but primary care physicians continue to refer a large number of elderly men for biopsy. It does not appear in the CaPSURE database that overtreatment occurs in the elderly. No difference in QOL was found comparing men younger and older than age 75 years. Regarding cost, the cost of a screen-detected CaP is about $2,300 compared to $10,000 for a screen-detected breast cancer case. In a study in Iowa, most screening in men over age 75 years was done by primary care physicians. He concluded that benefits of continued screening for men >75 years should be reassessed and comorbidities must be measured.

Presented by Badrinath R. Konety at the American Society of Clinical Oncology (ASCO) - 2008 Genitourinary Cancers Symposium - A Multidisciplinary Approach - February 14-16, 2008 San Francisco, California, USA

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS Professor & Chairman Department of Urology University of California, Davis, School of Medicine Sacramento, CA

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