A study by Louise C. Walter, M.D., of San Francisco Veterans Affairs Medical Center, California, and colleagues sought to quantify 5-year downstream outcomes following an abnormal prostate-specific antigen (PSA) screening result of 4.0 ng/mL or more, in older men. (Online First)
A total of 295,645 men 65 years or older that underwent PSA screening in the Veterans Affairs health care system in 2003 and were followed up for 5 years using national Veterans Affairs and Medicare data participated in the study. Among men whose index screening PSA level exceeded 4.0 ng/mL, researchers determined the number who underwent prostate biopsy, were diagnosed as having prostate cancer, were treated for prostate cancer, and were treated for prostate cancer and were alive at 5 years according to baseline characteristics.
In total, 25,208 men (8.5 percent) had an index PSA level exceeding 4.0 ng/mL. During the 5-year follow-up period, 8,313 men (33 percent) underwent at least one prostate biopsy, and 5,220 men (62.8 percent) who underwent prostate biopsy were diagnosed as having prostate cancer, of whom 4,284 (82.1 percent) were treated for prostate cancer. Performance of prostate biopsy decreased with advancing age and worsening comorbidity, whereas the percentage treated for biopsy-detected cancer exceeded 75 percent even among men 85 years or older, those with a Charlson-Deyo Comorbidity Index of 3 or higher, and those having low-risk cancer. Among men with biopsy-detected cancer, the risk of death from non-prostate cancer causes increased with advancing age and worsening comorbidity.
“Performance of prostate biopsy is uncommon in older men with abnormal screening PSA levels and decreases with advancing age and worsening comorbidity…Understanding downstream outcomes in clinical practice should better inform individualized decisions among older men considering PSA screening,” the study concludes.
(JAMA Intern Med. Published online April 15, 2013. doi:10.1001/jamainternmed.2013.323.