By Matthew D. Young, MD, MBA
More healthcare is not necessarily better healthcare, and when it comes to screening for cancer in older patients this can certainly be the case.
There is near universal agreement among medical professionals that men over 75 or with less than a ten-year life expectancy should not have routine PSA testing (prostate specific antigen – which is the prostate cancer screening test). Our society has worked hard to get across the message that early detection of cancer saves lives, but the simple fact is that not everyone will benefit from it and there are several reasons why this is:
- Most prostate cancer grows very slowly. So a man with a life expectancy of less than ten years should not be screened for prostate cancer. Those patients will almost certainly die of something else (like a heart attack or stroke), but not from prostate cancer.
- Screening has risks beyond a simple blood test. What if the PSA test is high? Many times the next step is a prostate biopsy or additional imaging (like an MRI). Both of these options have some risk that go along with them.
- Some patients have other significant medical problems (like heart failure or lung cancer), and relative to those problems, prostate cancer is not much of a risk.
- There is anxiety and worry that goes along PSA testing. What will the results be like and when will I know the answer? What other tests might be needed? If it wasn’t something that was going to kill you or shorten your life, then there was no need to borrow trouble.
Every patient needs to look at their own situation and have a discussion with their personal medical professional, but sometimes less is actually more.
Matthew D. Young, MD, MBA, is the Chief of Urology at Mission Health.