Written By As men age, their risk for developing prostate cancer increases. In response, doctors and medical organizations have recommended routine prostate-specific antigen (PSA) screenings to detect the cancer early. However, recent research has suggested that over-screening may be causing more harm than good, particularly for older men. In this article, we will explore the problem of over-screening and why too many older men are still being tested for prostate cancer.
The PSA test is a blood test that measures the level of PSA in a man’s blood. Elevated PSA levels can be a sign of prostate cancer, but they can also be caused by other factors, such as an enlarged prostate or infection. When a man has an elevated PSA level, he may be advised to undergo further testing, such as a biopsy, to determine if he has prostate cancer.
While routine PSA screenings have been widely recommended, recent studies have questioned the effectiveness of these screenings, particularly for older men. In 2012, the United States Preventive Services Task Force (USPSTF) recommended against routine PSA screenings for men over the age of 75, citing the potential harm of over-diagnosis and over-treatment.
Over-diagnosis occurs when a man is diagnosed with prostate cancer that is unlikely to cause harm during his lifetime. Over-treatment occurs when a man undergoes treatment for prostate cancer that may not be necessary, such as surgery or radiation therapy, which can have significant side effects, including impotence and urinary incontinence.
Despite these recommendations, many older men continue to undergo routine PSA screenings. According to a study published in JAMA Internal Medicine in 2016, over 60% of men over the age of 75 had undergone PSA screening within the previous year. This suggests that many older men may not be fully informed about the potential harms of over-screening and the limited benefits of PSA testing.
Furthermore, there may be financial incentives for doctors to continue recommending PSA screenings. In some cases, doctors may order unnecessary tests to generate revenue, rather than to benefit their patients. This can lead to a cycle of over-testing and over-treatment that can harm patients and strain the healthcare system.
To address the problem of over-screening, it is important for doctors and patients to have open and honest discussions about the risks and benefits of PSA testing, particularly for older men. Patients should be informed about the potential harms of over-diagnosis and over-treatment, and should be given the opportunity to make informed decisions about their healthcare.
In addition, medical organizations and policymakers should work to address the financial incentives that may contribute to over-screening. This could include reforming the payment system for medical services, implementing guidelines for appropriate PSA testing, and increasing education and awareness about the potential harms of over-screening.
In conclusion, over-screening for prostate cancer is a significant problem, particularly for older men. While routine PSA screenings may have been widely recommended in the past, recent research has suggested that over-screening may cause more harm than good. To address this problem, it is important for doctors and patients to have open and honest discussions about the risks and benefits of PSA testing, and for medical organizations and policymakers to work to address the financial incentives that may contribute to over-screening. By doing so, we can help ensure that older men receive the best possible care, while minimizing the potential harms of over-screening.
