Many older men still get prostate screening: study

US - Most elderly men still get tested for prostate cancer despite US recommendations not to screen men aged 75 and older, according to a US study.

Prostate cancer screening policies have been the topic of much debate in the United States recently, trying to find a balance between potentially harmful interventions for many who develop slow-growing cancer that might never hurt them, against hunting down and treating a cancer that kills 32,000 a year.

"I think there is a lot of push from patients to get (the test)," said Edward Messing from the University of Rochester Medical Center, who worked on the study.

"Eighty-year-olds don't think they're that old anymore, and maybe they're not. They think they still have a life ahead of them."

In 2008, the US Preventive Services Task Force (USPSTF), a federally-funded panel, issued guidelines advising against screening older men for prostate cancer.

"In this age group we have no evidence of benefit. We have ample evidence of harm," said Michael LeFevre, a co-chair of the task force.

Prostate cancer is common in the elderly. LeFevre said some studies have estimated that as many as half of men over age 75 have the cancer - but it's typically slow-growing, and often doesn't pose a serious threat compared to other chronic conditions.

In some cases, biopsies and treatment can do more damage to men's bodies than the cancer itself, he added.

So in weighing the risks and benefits, the USPSTF decided that older men are better off without routine screening, and new draft outlines not covered in the study argue against routine screening in all men, regardless of age.

To determine whether the 2008 recommendations have had any impact on the number of men who get tested, Messing and his colleagues looked to surveys given before and after the guidelines were released.

In 2006, 9,000 older men responded to questions about whether they had been given a prostate specific antigen (PSA) test, which looks for a protein that is elevated in men who have cancer.

Sixty per cent of them reported that they had received a PSA test within the last year, according to findings published in the urology journal BJU International.

That compared to 63 per cent of 12,000 men surveyed in 2008 and 60 per cent of 14,800 survey participants in 2010 who said they'd had a PSA test.

The findings jibe with those from another study released this week in the Journal of the American Medical Association, which found no change in the number of older men who reported a recent PSA test between 2005 and 2010 based on other survey data.

The benefits of screening are thought to be lower in older men because they have a shorter life expectancy. But Messing told Reuters Health that he disagrees with a blanket policy against testing elderly men for prostate cancer.

He pointed out that the disease kills older men in greater numbers than younger men, and screening them might catch those cancers early.

In addition, some men in their 70s and 80s can live another 10 to 20 years. Prostate cancer screening decisions should be made based on whether they are likely to live long enough to see the benefits of that screening, rather than solely based on their age, Messing added.

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