Posted: October 10, 2013

In a recent JAMA research letter,  Dr. Jaramillo and colleagues from the University of Texas Medical Center at Galveston reveal an unfortunate trend: PSA screening in men over 75.  All the august bodies who advise on prostate cancer screening (Americal Cancer Society, USPSTF, American College of Surgeons, American Society of Clinical Oncology, American Urological Association) advise against screening men over 75 because the death rate from other causes overwhelms death from prostate cancer in this age group.  Nonetheless, by reviewing Medicare claims data, these investigators were able to show that 41% of men over 75 in Texas got screened by PSA and 29% of men did so on the recommendation of their PCP.  The authors postulate that busy PCP’s find it easier to order the PSA than to sit down and discuss with the patient why the test is not necessary.  Furthermore, fear of litigation is thought by the authors to drive some doctors to over-order this much maligned test.  Dr. Stark opines, “Current thinking is that fear of litigation adds relatively little to the cost of health care, but if these investigators are correct, the increment may be larger than previously thought.  The morbidity and expense from an elevated PSA in this age group is not to be understated.  Arguably a 75 year old in excellent health with a good heart and lungs and no other major co-morbidities could be the exception to the rule, but by and large doctors are adding the the nation’s health care burden by ordering this test in elderly men.    Whether the Texas experience exemplifies national trends is as yet unknown.  If you want the whole article send me an email (see form on this page) .  Copyright laws prevent me from sharing it with you on this website. ”

Update 2020: screening of elderly men for prostate cancer continues unabated despite more attention than ever to cost/benefit.  The drivers continue to be physician overenthusiasm and fear of litigation if they fail to screen, despite the opportunity to have an informed discussion with their patient.s