Men over 70 undergoing low-value prostate cancer screening

CANCER DIGEST – Jan. 4, 2023 – An analysis of Medicare data shows that men over 70 may be undergoing unnecessary prostate cancer screening contrary to guidelines. The study appears in the January 2023 Journal of the Board of Family Medicine.

The study by researchers from Wake Forest University School of Medicine examined prostate screening testing among primary care providers. In particular they looked at primary care visits for men over the age of 70. The data showed that among these men 6.71 prostate specific antigen (PSA) tests were ordered per 100 visits and 1.65 digital rectal exams (DRE) per 100 visits.

The United State Preventive Services Task Force changed its screening guidelines in 2018 to recommend against screening men over 70. In 2013, the American Urological Association recommended against PSA-based screening for men over the age of 70.

Chris Gillette, PhD, associate professor of Physician Assistant studies at Wake Forest School of Medicine and principal investigator on this study said in a press release that screening is complex because while some prostate cancers can be aggressive, most are slow-growing that may never cause symptoms or death.

“As a man ages, the risk for a false-positive result increases,” Gillette said. “Men who are 70 years and older are at the highest risk for over diagnosis.”

The study also showed that providers who order a lot of tests are more likely to order low-value screenings such as a PSE or DRE. The results also showed that for each test ordered there was a 49 percent increase in the odds of a low-value PSA and a 37 percent increase in the odds of a low-value DRE.

Why so many tests are being ordered is unknown. Gillette speculated that providers might be responding to patient requests when ordering screening tests, or they may be using a "shotgun" approach to medical testing where all possible tests are ordered during a patient visit.

"Providers need to engage patients in these discussions on the complexity of this testing," Gillette added in the press release. "Ultimately, when and if to screen is a decision best left between a provider and the patient."

Sources: Wake Forest School of Medicine press release and Journal of the American Board of Family Medicine