Earlier Start, Stop for PSA Testing?
Prostate Cancer Screening May Start Earlier -- and Stop Sooner
Can PSA Screening Stop at 75?
Since prostate cancer takes a while to develop -- and even longer to become deadly -- there's obviously an age beyond which prostate cancer screening will result in far more risk than benefit. But what's that age?
Sharlip says the rule of thumb is to stop PSA screening when a man's probable life expectancy is less than 10 years.
"With good life expectancy, a man is at risk of prostate cancer and death if he doesn't get his PSA tested," Sharlip says. "But what about a man with rising PSA that's still at a marginal level? That is exactly the situation that is poorly defined."
Help comes from Anna Kettermann and colleagues at Johns Hopkins University. Kettermann and colleagues collected data from 849 men participating in the Baltimore Longitudinal Study of Aging.
Eighteen of the men died of prostate cancer. Not even one had a PSA under 3.0 ng/mL. Moreover, men with PSA levels this low had virtually no chance of serious prostate cancer or PSA levels that later soared.
"We wanted to look for the men who have PSA values that will never bring them to the condition that prostate cancer will kill them," Kettermann tells WebMD. "If a man is old and has a low PSA and a history of low PSA, he is unlikely to develop high-risk disease."
Sharlip warns that the findings are not necessarily dire for elderly men with PSA levels above 3 ng/mL.
"I follow these men carefully, get a PSA test every three months, and if I see the PSA turning up I recommend a biopsy," he says. "In a number of these elderly men I find only low-risk prostate cancer, so I don't treat them -- as it turned out, they didn't need the biopsy. But more than occasionally I find intermediate- or high-grade prostate cancer, and those are the men we want to know about."