Study disputes prostate tests' value to elderly

WASHINGTON - Millions of dollars are spent annually to monitor prostate health in men older than 75 even though research shows little benefit in screening such men for prostate cancer, a study says.

"There is no evidence that screening men of this age would be beneficial to them, so this may not be the best use of health care resources," said Dr. Siu-Long Yao, an oncologist at the Cancer Institute of New Jersey in New Brunswick and senior author of the study appearing this week in the Journal of the National Cancer Institute.

"If you take all elderly men who die and do an autopsy, 30 to 70 percent will have prostate cancer, but they died of something else," Yao said. "Diagnosing the prostate cancer may lead to unnecessary complications in elderly patients who are more likely to die of something else, such as cardiovascular disease."

However, Dr. Richard Middleton, chairman of urology at the University of Utah Medical School and a contributor to the prostate cancer guidelines for the American Urological Association, said the study was "too simplistic."

"A routine PSA (prostate specific antigen test) in a man over 75 would ordinarily not be necessary," but the blood test would be useful for a man with a history of prostate problems, he said.

Middleton said PSAs are needed to monitor for the recurrence of tumors in elderly men who have had surgery or radiation for prostate cancer. PSAs also are appropriate, he said, for elderly men who have a suspicious-looking prostate on examination, who have a known tumor or who have a history of an elevated PSA count.

In a survey of 7,889 men, researchers found 32.5 percent of men older than 75 received PSA blood tests, an estimated 1.5-million men a year nationwide. Medicare typically pays $25.70 for the lab work, federal officials said, suggesting more than $38-million is spent on those tests.

The PSA test does not detect cancer directly. Instead, it determines, in effect, if a patient has too much prostate tissue. That excess tissue can be caused by inflammation, by enlargement common to older men or by cancer. A positive PSA test has to be followed up with a biopsy or other procedures before cancer can be confirmed.

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