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Prostate cancer: to screen or not to screen

Created date

June 21st, 2011

' Matt Narrett, M.D., is a chief medical officer for Erickson Living and directs the provision of medical care at all Erickson Living communities. He received his medical degree from Harvard Medical School and is board certified in internal medicine and geriatrics. He is co-author of Old is the New Young, a guide to successful aging (available on

One of the most controversial areas in medicine today is whether the screening blood test for prostate cancer, which checks prostate specific antigen (PSA) levels, is effective at finding cancer early and preventing disease-related complications and deaths. The PSA is a protein produced by prostate cells, and an elevated level can be associated with prostate cancer or other common conditions such as prostate enlargement (benign prostatic hypertrophy, or BPH). A recent study published in theJournal of Clinical Oncologyfound that rates of PSA screening in the U.S. are higher for men in their 70s (in fact almost twice the rate) than for men in their 50s. Furthermore, men in their 80s were found to be screened about as often as men in their 50s.

How long to screen

Most (but not all) experts agree that men should begin PSA testing at age 50 and then regularly till age 75 as long as their life expectancy is ten years or more. But the value of screening men above the age of 75 or 80 is much more controversial, as there is little if any data that screening is associated with better outcomes for this age group. That s because prostate cancer typically grows very slowly, and elderly men will often die of an unrelated disease before the prostate cancer would have ever become a problem. As a result, there is concern in the medical community about excessive PSA screening, especially for those with limited life expectancies. Both the American Cancer Society and the American Urological Society discourage screening for men whose life expectancy is 10 years or less. The United States Preventive Services Task Force recently concluded that screening should stop entirely at age 75. Other experts believe that the frequency of screening should be contingent upon someone s health status and life expectancy no matter what his age. Whether or not to have a PSA blood test should be based upon a careful discussion with your medical provider and then ultimately your own understanding of the risks and benefits of testing. An elevated PSA will often lead to biopsies and other testing, and if cancer is found, treatment may involve surgery to remove the prostate or radiation to destroy the cancer. These procedures can result in unpleasant side effects such as impotence and incontinence; you want to be confident that undergoing testing and procedures will benefit you in the long run. Not an easy decision but certainly one that you should make with adequate information and careful consideration. In good health, Dr. Narrett