The study, led by Louise C. Walter, M.D., of San Francisco Veterans Affairs Medical Center, included a total of 295,645 men 65 years or older who underwent PSA screening in 2003. The participants were followed up for a total of five years.
Prostate cancer tends to develop in men over the age of 50, it is the sixth leading cause of cancer-death among men. Currently, the U.S. Preventive Services Task Force and American Cancer Society advise against PSA screening among men with a limited life expectancy. In fact, according to a US government-sponsored panel of independent experts, the harms of PSA-based testing for prostate cancer outweigh the benefits.
The authors said:
"Despite ongoing controversies surrounding prostate-specific antigen (PSA) screening, many men 65 years or older undergo screening. However, few data exist that quantify the chain of events following screening in clinical practice to better inform decisions."
The researchers identified the number of men with a PSA level above 4.0 ng/mL who underwent prostate biopsy, had prostate cancer, received prostate cancer treatment, and survived after 5 years of treatment.
The team gathered and examined data on 295,645 men - 25,208 (8.5 percent) had a PSA level above 4.0 ng/mL. 8,312 of them (33 percent) underwent a prostate biopsy procedure, of whom 5,220 were diagnosed with prostate cancer and 4,284 received treatment.
There were fewer biopsies carried out among the older patients. However, 75% of those who were diagnosed with cancer received treatment, this included patients over the age of 85 and with high or low risk cancer.
The risk of death from non-prostate cancer causes among men who were diagnosed with the disease increased as they got older.
The study concluded:
"Performance of prostate biopsy is uncommon in older men with abnormal screening PSA levels and decreases with advancing age and worsening comorbidity...Understanding downstream outcomes in clinical practice should better inform individualized decisions among older men considering PSA screening."
Writtenby Joseph Nordqvist