PSA Screening Among Elderly Men With Limited Life Expectancies

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Abstract
Most screening guidelines do not recommend prostate-specific antigen (PSA) screening in elderly men with limited life expectancies because potential harms of screening, which occur immediately, outweigh potential benefits, which are not expected to occur until several years in the future.1-6 For example, the American Cancer Society and the American Urological Association recommend annual PSA screening for average-risk men aged 50 years and older if they have more than a 10-year life expectancy, which is usually defined as having greater than a 50% probability of surviving 10 years.1,2 The US Department of Veterans Affairs (VA) and the US Preventive Services Task Force conclude that evidence is insufficient to recommend routine PSA screening, and men with a low probability of surviving 10 years are unlikely to benefit from screening even under favorable assumptions.3,4 All agree that currently there is no conclusive evidence that PSA screening reduces prostate cancer mortality at any age or life expectancy and convincing evidence of benefit is unlikely to ever exist for elderly men because ongoing randomized trials of PSA screening have excluded men older than 75 years.7 It is these men, especially those in poor health, who will probably experience only the adverse effects of screening, such as additional procedures due to false-positive results, psychological distress, or the morbidity associated with treating clinically insignificant prostate cancer detected by screening.4,5

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