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Why is PSA test not recommended for men over 70?

roboticoncology.com - Should men over 70 get a PSA test? - RoboticOncology.com

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Should men over 70 get a PSA test?

In my area of medicine, there’s the ongoing question of whether men over age 70 should still be screened for prostate cancer with a PSA blood test. This debate has continued for years but one thing that’s certain is that men are living longer. Could we be missing cancer in older, healthy men who really need to be treated? Is the cutoff for PSA’s at age 70, still relevant when a significant portion of men may have many years of life ahead of them?

Many guidelines recommend against PSA screening in men older than 70 to 75 years because of the risk of over diagnosis and lack of evidence of a mortality reduction in this age group. It’s believed that the harms of screening might outweigh the benefits in an older population. This is now coming into question more and more as men live longer and many of those men are still healthy and active as they grow older.

PSA testing overview

Prostate specific antigen (PSA) is a protein produced by normal as well as malignant cells of the prostate gland and is found in the blood. The PSA test measures the level of PSA in a man’s blood. For this test, a blood sample taken at a doctor’s office is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter (ng/ml) of blood. The blood sample taken is used to monitor the level of PSA being produced by the prostate. The PSA test became available in the early 1990s and is a simple test used to monitor the PSA levels over a period of years. When this is done regularly, urologists are much better able to detect spikes or elevations in a man’s PSA level. One aspect looked at is PSA velocity. PSA velocity is the rate at which a man’s PSA levels change over a period of time. PSA mapping is the best way to determine if elevations are a cause for concern such as prostate cancer.

New study questions stopping PSA at age 70

A recent study of approximately 7600 men participated in the Goteborg-1 prostate cancer screening trial. At the end of the study, researchers found that men diagnosed with a Gleason score 3+4 or higher cancer when compared with men with a lower grade cancer, had an 11% increase for prostate cancer with each 1-year in age. Of the approximately 7600 men in the study, 1022 were diagnosed with prostate cancer with a median age at diagnosis of 65 years. Researchers with the study questioned what age is best to stop PSA screening for the early detection of prostate cancer. From their findings, older men screened for prostate cancer may have an increased risk of higher-grade and possibly more aggressive prostate cancer that needs treatment. With prostate cancer treatment becoming better and better utilizing active surveillance, improved interpretation of PSA tests and other biomarkers ruling out aggressive disease, these men should be tested and given guidance on how best to treat it.

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Take home message

It is expected that the population of people older than age 65 in the United States will approach 83.7 million, making up approximately 20% of the overall population. Prostate cancer is the second most common cancer in American men, and the incidence of this disease increases with age. Giving the aging population, the incidence of prostate cancer in the U.S. is expected to climb as high as 382,000 diagnoses annually in 2030 – nearly 2.5 times higher than the diagnoses in 2017. With this knowledge, it vital that we provide expert screening, treatment, and long-term survivorship care for older men with prostate cancer in the coming years. That’s why to stop PSA testing at age 70 is not a solution. If men over the age of 70 are not getting a PSA test, think of the men with prostate cancer that would be undiagnosed. It’s been shown that older men who have a PSA blood test are less likely to be diagnosed with high-risk prostate cancer. For the men either who declined or were not offered PSA testing, had more than a three-fold higher risk of having a high-grade prostate cancer diagnosis, impacting their ability to fight off the disease successfully if it had been found at an earlier, more treatable stage. It’s time to continue PSA testing for men 70 and older to offer men the right to make good medical decisions in their best interest and to provide care and treatment if diagnosed with prostate cancer. Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy. Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncolo gy and prostate cancer 911.

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roboticoncology.com - Should men over 70 get a PSA test? - RoboticOncology.com

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