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Many Men With Low Life Expectancy Still Undergo PSA Screening – Renal And Urology News –

More than 1 in 5 older men with low life expectancy still undergo PSA screening for prostate cancer regardless of age group, according to a new report.

In the 2020 Behavioral Risk Factor Surveillance System, 57,397 men aged 60 years or older reported receiving a PSA screening test in the past 2 years. The estimated 2-year prostate cancer screening rates were 36.3% among men aged 60 to 64 years, 42.8% among men aged 65 to 69 years, 47.1% among men aged 70 to 74 years, 42.7% among those aged 75 to 79 years, and 30.4% among men aged 80 years or older.

The frequency of prostate cancer screening decreased with lower life expectancy in each age category, Kevin H. Kensler, ScD, of Weill Cornell Medicine in New York, New York, and colleagues reported in JAMA Network Open. PSA screening decreased from 43.4% among men with the greatest life expectancy to 30.4% among men with the lowest life expectancy.

Among men with the lowest estimated life expectancy — an estimated 71% or greater risk of death within 10 years — more than 20% in each age group still underwent screening, however, the investigators reported. Men age 70-74, 75-79, and 80 years or older with the lowest estimated life expectancy only had 26%, 43%, and 20% decreased odds of PSA screening, respectively, compared with their healthiest peers. The study estimated life expectancy using an index by Cruz et al that was later adapted. Models adjusted for factors related to health care access and use, including race and ethnicity, health insurance status, annual income, educational attainment, and marital status.

The 2023 AUA-SUO prostate cancer screening guideline specifies that older men with less than a 10-year estimated life expectancy are not likely to experience a survival benefit from continued screening. Select men older than 70 years with an estimated life expectancy of at least 10 years, however, can continue to receive PSA screening every 2-4 years following shared decision-making because these men may still benefit from prostate cancer interventions, if indicated.

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According to the AUA-SUO guideline, life expectancy tables and tools tend to be more reliable than clinician judgment. They mentioned several tools. A simple tool is the Social Security life tables, wherein men in the US older than 77 years have less than a 10-year life expectancy. The Michigan Urological Surgery Improvement Collaborative (MUSIC) has a life expectancy tool that includes comorbidities. Insurance companies also tend to have comprehensive tools.

“PSA-based screening rates have increased among males aged 70 years and older in recent years, suggesting that enhancements to the shared decision-making process are needed to ensure that older males who undergo screening are those who may potentially benefit,” Dr Kensler’s team wrote.