Some older men may safely stop PSA testing

Men who are 75-80 years old and have a low prostate specific antigen (PSA) level—that is, less than less than 3 nanograms per milliliter—are unlikely to develop life-threatening prostate cancer during their remaining life span, according to newly reported findings.

“Therefore, these men may represent an ideal target group for discontinuation of PSA testing,” Dr. Edward M. Schaeffer and colleagues conclude in the Journal of Urology.

Such a strategy, they continue, “could dramatically reduce the costs associated with screening,” as well as cutting the risks of the potential complications from “additional evaluations and/or treatment in a population unlikely to experience benefit.”

Although the optimal age for stopping PSA screening is controversial, they add, screening rates in elderly men are high, often exceeding rates among those in their 50s.

The current study included 849 men aged 40 years and older with serial PSA measurements. “Of the 154 participants older than 75 years with PSA less than 3 ng/mL (nanograms per milliliter), none died of prostate cancer, and high-risk prostate cancer developed in only one,” Dr. Schaeffer, at Johns Hopkins School of Medicine, and his team report. The latter patient had a PSA of 2.9 ng/mL, but did not die of his disease.

Five other men had non-high-risk prostate cancer after age 75, with PSAs of no higher than 3 ng/mL. Four died of other causes, while the remaining subject remains alive 8 years after the diagnosis of prostate cancer.

“If confirmed, these findings may be useful in determining more concrete guidelines for when PSA based screening might be safely discontinued,” the investigators suggest.

SOURCE: Journal of Urology, April 2009.

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