Practice Patterns In Screening And Management Of Prostate Cancer In Elderly Men
Prostate cancer (CaP) screening guidelines are clear about when to initiate screening but only state that it should be discontinued when a man’s life expectancy decreases to less than 10 years. Using these criteria and the fact that a man in his mid-to upper 70s in the United States has a 10-year life expectancy, it is understandable that physicians might perform PSA screening in men older than 75 years. Dr. Konety and colleagues assessed the practice patterns of PSA screening by physicians in Iowa by individual physician survey. The authors note that Iowa has the fourth largest population older than 65 years in the US and the second greatest proportion of people older than 85 years.
A pilot tested survey instrument was sent to 3,105 licensed healthcare providers from internal medicine (n=702), family practice (n=1,740), urology (n=78), medical oncology (n=13), radiation oncology (n=20) and physician’s assistants (n=555). Of the 3,105 individuals surveyed, 32% (997) responded; 792 on the first mailing and 205 on a second mailing. Most survey responders perform PSA screening in men 75 years and older and consent to screening at a patient’s request.
The age to initiate screening varied by specialty with 45-50 years preferred by 43% of family practitioner, 36% of internists, 13% of oncologists and 47% of urologists. 54% of family practitioner, 62% of internists, 87% of oncologists and 51% of urologists preferred a screening initiation age of 51-60 years. A screening age of 61-70 years was preferred by 2% of family practitioner, 2% of internists and 2% of urologists. A preference to never stop screening was reported by 4% of family practitioner, 3% of internists, 3% of oncologists and 2% of urologists.
Provider age and specialty correlated with the decision to screen elderly men. Older providers (greater than 51 years) were significantly more likely to screen even in elderly men. Family practitioners were also more likely to screen elderly patient s compared to other types of providers.
The survey also asked about CaP treatment preferences in patients age 75 years or older. Watchful waiting was preferred by 45%, and of those who recommended active therapy, 14% suggested radiotherapy, 5% surgery and 27% hormonal therapy.
These data indicate that a majority of healthcare providers in the State of Iowa perform CaP screening in men older than 75 years. The authors suggest that this may represent a lack of awareness that benefits of screening decline with age.
Konety BR, Sharp VJ, Verma M, Williams RD, The Iowa Prostate Cancer Consensus Panel
Urology 2006; 68(5):1051-56.
Reviewed by UroToday.com Contributing Editor Christopher P. Evans, MD