81-year-old billionaire Warren Buffett was diagnosed with prostate cancer after having the finding initially detected through a screening blood test to measure a cancer marker called prostate specific antigen or PSA.
However guidelines from a national task force that have been in place since 2008 recommend against the use of PSA screening in men over age 75 due to its lack of benefit. However it is found that nearly 44 percent of men of Buffet’s age got screened with a PSA test in 2010, a rate that has remained unchanged since 2005, according to a research letter published Tuesday in the Journal of the American Medical Association.
The study researchers from the University of Chicago Medical Center reviewed 2010 government survey data from nearly 5,000 men ages 40 and over and compared it with data from five years earlier, finding that the new guidelines haven’t changed physician practices when it comes to referring older men for PSA screening. In fact, PSA screening in men over 75 was more common than in men in their 50s; men ages 60 to 74 had the highest screening rates: 51 percent.
“PSA screening for more than 40 percent of men 75 or older is inappropriate,” said Dr. Scott G. Eggener, an assistant professor of surgery at University of Chicago Medical Center. “Selective screening is reasonable to consider for the healthiest men over age 75, but for the large majority of men in this age group, early detection can lead to treatment of a disease that will probably never cause a problem,” he said.
Eggener and his colleagues used data from the 2005 and 2010 National Health Interview Surveys, in which a representative sample of the U.S. population was interviewed. The study authors said their data likely underestimated the rate of men underdoing PSA testing, because self-reports are lower than rates found when researchers review actual medical records.
“Doctors either believe in PSA screening or they don’t,” said Dr. Anthony D’Amico, chief of genitourinary radiation oncology at Brigham and Women’s Hospital, who was not involved with the study. “If they believe in it, they give it to all older men, and if they don’t, they offer it to no one. I think that practice needs to change.” D’Amico said European data clearly show that PSA screening can lower the likelihood of dying from prostate cancer but that screening needs to be used judiciously only in healthy men who have a high probability of living for a decade or more. In the research paper, doctors seemed to make no distinction between screening those in good health and screening the sickest of the population.
Nearly 20 percent of men screened of all the men screened reported that they were in “fair” or “poor” health, while one-third of the total screened population had a high likelihood of dying within the next nine years due to other health problems such as heart disease.
In 2008, the USPSTF issued a recommendation that found limited benefit for screening men ages 75 and older for prostate cancer. Last year, the task force drafted guidelines that said prostate screening was of limited benefit for helping men of any age live longer, and that harms of unnecessary treatments often outweigh benefits.
However, there are exceptions, prostate cancer expert Dr. Patrick Walsh, a urology professor at Johns Hopkins Medical Institutions in Baltimore, cited a University of Rochester study appearing last year in the journal Cancer that found half of the deaths from prostate cancer “occur in men who are diagnosed after the age of 75.” “The fact is that older men who are diagnosed with prostate cancer oftentimes have more advanced disease than younger men — the opposite of what we used to believe,” Walsh said. Some older men can have aggressive Stage 1 tumors, which despite being confined to the prostate gland, contain highly abnormal cells capable of spreading quickly, Walsh explained.
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