A recent Renal&Urology news story heralds, “The risk of dying from prostate cancer is low among older men receiving routine screening, investigators report.”^[i](In this case, older refers to men ages 70-74.) At first glance, that sounds like encouragement to continue annual PSA screening as you age—an idea that conflicts with the 2018 U.S. Preventive Services Task Force (USPSTF) recommendation against PSA screening for men age 70 and up.

However, the study described in the news is more complex than the opening sentence suggests. The Jan. 2024 study reports long-term results from the Dutch arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). The ERSPC was launched in the early 1990s. It is an enormous ongoing multicenter effort to evaluate the effect of PSA screening on prostate cancer (PCa) death rates. Its aim was to determine if PSA tests should be part of general healthcare.

To give you an idea of the scope of the Dutch arm, starting in 1993 participants (ages 55-74) were recruited. They were randomized into groups. In the intervention group, the received PSA tests every four years until age 74 (maximum five screening rounds over 20 years). If a participant’s PSA was 3.0 ng/ml or more, he was advised to have a sextant (6 needle) TRUS biopsy. (The Dutch Cancer Registry was annually referenced to pick up cases diagnosed outside the screening setting). Anyone diagnosed with PCa was followed by a twice-yearly chart review until PCa progression or death.

In 2019, 16-year followup data was published on over 182,000 men, most of them ages 55-69. At that time, the authors stated that PSA screening significantly reduces the death rate from PCa. They noted, “Repeated screening may be important to reduce PCa mortality on a population level.”^[ii]

Now the 2024 paper focuses on the incidence of PCa-specific mortality up to age 85. The participants were 7,052 men ages 70-74 “at their last screening visit after undergoing a maximum of three screening rounds without being diagnosed with PCa.”^[iii] They were followed for an average of 16 years and the data was analyzed. The authors concluded, “Men aged 70–74 yr who have previously undergone PSA-based screening without receiving a PCa diagnosis have a very low risk of dying from PCa by the age of 85 yr.” In turn, this suggests two criteria to help 70-74 year old men who have been regularly screened to decide if they should continue regular PSA tests:

1. Those who have participated in screening, whose PSA is less than 3.0 ng/ml, and who have had previous negative prostate biopsies may discontinue screening, and
2. Those with higher PSA levels but no prior biopsies may consider continued screening if life expectancy exceeds 10 yr.

While the study points to very low risk of death due to PCa for older men who have been screened all along, the study’s additional details provide superior guidance over the USPSTF’s recommendation to discontinue screening at age 70. Keep in mind that as men age, their PCa risk increases because cancer is an aging-related disease. Therefore, it is still important for each man, in discussion with his doctor, to consider his own health, family history, PSA records and life expectancy before choosing to continue PSA screening or not.

Finally, if a routine PSA blood test registers a suspicious increase, we advise a) waiting several weeks and repeating the test in order to rule out lab error or temporary source of prostate stimulation, and b) scheduling a 3T multiparametric MRI of the prostate to decide if a biopsy is in order (or not).

The “Golden Years” should be a time of wellness, vigor, and high quality of life. Think of aging well similar to getting the most years out of your car through scrupulous maintenance. Healthy diet habits and regular aerobic exercise are important to keep your body running smoothly—and regular PSA tests are as important to your body as knowing your car’s oil level.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Natasha Persaud. “Prostate Cancer Death Rate Low in Older Men Receiving PSA Screening.” Renal&Urology News, Jan. 9, 2024. https://www.renalandurologynews.com/news/urology/prostate-cancer/prostate-cancer-death-rate low-in-older-men-receiving-psa-screening/
[ii] Hugosson J, Roobol MJ, Månsson M, Tammela TLJ et al. A 16-yr Follow-up of the European Randomized study of Screening for Prostate Cancer. Eur Urol. 2019 Jul;76(1):43-51.
[iii] de Vos II, Remmers S, Hogenhout R, Roobol MJ; ERSPC Rotterdam Study Group. Prostate Cancer Mortality Among Elderly Men After Discontinuing Organised Screening: Long-term Results from the European Randomized Study of Screening for Prostate Cancer Rotterdam. Eur Urol. 2024 Jan;85(1):74-81