Researchers have found that older males may be overscreened for prostate cancer, despite national guidelines outlining the limited value of such screening.
They said their research, published Tuesday in the journal JAMA Network Open, indicates that clinician-level interventions has the potential to reduce overscreening.
Prostate cancer is the fifth leading cause of cancer-related deaths in men worldwide, yet most cancers identified through screening are indolent, posing minimal threat to length or quality of life. While screening for prostate cancer may reduce mortality, it comes at the risk of overdiagnosis, particularly in older males or those with comorbidities.
Serum prostate-specific antigen (PSA) tests in males unlikely to benefit from prostate cancer intervention may expose these individuals to unnecessary anxiety, invasive biopsies, and overtreatment, according to the study.
Given the lack of evidence of the clinical benefits of PSA screening in older males, the U.S. Preventive Services Task Force (USPSTF) published revised guidelines in 2018 advising against PSA screening in males 70 or older due to the risk of false-positive results and overdiagnosis of indolent tumors. They recommended that males aged 55 to 69 discuss potential benefits and risks with their physicians before deciding whether to undergo PSA screening.
To identify the factors associated with low-value PSA screening in males 70 years or older, the researchers analyzed a cohort from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), an annual nationwide survey conducted by the Centers for Disease Control and Prevention.
The cohort comprised 32,306 male respondents to the BRFSS survey. Most (87.6%) were white; 1.1% American Indian; 1.2% Asian; 4.3% Black; and 3.4% Hispanic. Within this cohort, 42.8% of respondents were aged 70 to 74 years, 28.4% were 75 to 79, and 28.9% were 80 or older. Males with former or current prostate cancer diagnoses were excluded. Recent screening was defined as PSA testing within the past two years. Weighted multivariable logistic regressions and two-sided significance tests were used to characterize factors associated with recent screening.
In the study, recent PSA screening rates were 55.3% for males in the 70-to-74-year age group, 52.1% in the 75-to-79-year age group, and 39.4% in the 80-year-or-older group. White males had the highest screening rate (50.7%), and American Indian males had the lowest (32.0%). Married men were screened more than unmarried men, as were men that had a primary care physician, a post-high school educational level, and income above $25,000 per year. Discussing PSA testing benefits with a clinician was also associated with increased screening, suggesting that clinician discussions could also increase adherence to age-based PSA testing guidelines.
According to the researchers, the results, indicating that older males were overscreened for prostate cancer despite the national guidelines, may inform interventions to disincentivize such low-value screening -- such as direct patient education on the risks of PSA screening for older males. The researchers suggest further studies quantifying the implications of PSA screening, specifically the consequences of overtreatment.