Rethinking Prostate Tests: Why Screening May Not Benefit Older Men

When Warren Buffett announced at the age of 81 that he had been screened for prostate cancer and was planning to seek treatment, prostate cancer experts were dismayed. For quite some time, they’ve been advocating against prostate cancer screening for men aged 75 and older.

Scott Eggener, M.D., an assistant professor of surgery at the University of Chicago Medicine, explains, “PSA (prostate-specific antigen) screening for men aged 75 or older is inappropriate. Selective screening might be worth considering for the healthiest men over the age of 75. Still, for the majority of men in this age group, early detection can lead to treating a disease that will likely never cause a problem. A significant percentage of men over 75 with an elevated PSA will die from something else before prostate cancer interferes with the quality or duration of their life.”

Despite this expert advice, many doctors and their elderly patients continue to undergo prostate screening tests. According to statistics, since the United States Preventive Services Task Force recommended against testing prostate cancer in men aged 75 years or older in 2008, nearly 50 percent of men in that age group continue to get screened. Alarmingly, this number keeps climbing rather than dwindling.

The Problem with Screening Older Men

Early detection and treatment of prostate cancer in older men can have a host of unintended consequences that are both physically and financially detrimental. Potential negative outcomes include overdiagnosis and overtreatment, as well as an increased risk of complications and adverse side effects from both diagnosis and treatment.

Overdiagnosis refers to identifying and treating prostate cancer that would never have progressed to the point of causing harm or death. In many cases, the treatment may be unnecessary and even downright harmful. Overtreatment can lead to a host of medical issues, including urinary incontinence, erectile dysfunction, and other complications that can significantly impact the quality of life for older men.

Moreover, most prostate cancers grow at an incredibly slow pace. It’s not uncommon for men to live with the disease for decades without experiencing any symptoms or health issues. In fact, the majority of men above 75 will die from other causes, not prostate cancer itself. Consequently, many older men who are screened and diagnosed with prostate cancer may face the additional emotional stress and anxiety of living with a cancer diagnosis, even though it won’t significantly impact their lives.

Why Are Men Still Being Screened?

Despite the mounting evidence against the routine screening of men aged 75 and older, many healthcare providers continue to suggest regular prostate exams. Several reasons could be contributing to this trend. For instance, medical professionals may be reluctant to change their long-standing routines, fearing potential lawsuits if they fail to detect cancer in time to treat it.

On the other hand, some older men who are concerned about their health and well-being may actively seek and demand screening tests without a full understanding of the potential risks and consequences. Many of them are accustomed to annual checkups and tests and may feel that skipping this particular screening puts them at risk.

Ultimately, healthcare providers and patients need to have honest, informed conversations about prostate cancer screening to empower men aged 75 and older to make an educated decision about their healthcare.

The Right Approach

One efficient way to discuss the subject is for healthcare providers to encourage older men to consider their overall health, life expectancy, and other factors before deciding to get screened for prostate cancer. For instance, a man with numerous chronic health conditions may not benefit from early detection or treatment, as the potential negative outcomes might outweigh prostate cancer’s potential impact on his life. On the other hand, a healthy older man might choose to undergo selective screening, especially if he has a family history of aggressive prostate cancer.

It’s crucial to maintain open lines of communication and strive for personalized healthcare approaches tailored to each individual’s unique situation. Healthcare providers should educate themselves on the latest research and guidelines regarding prostate cancer screening for older men and be prepared to answer their patients’ questions and concerns transparently.

To sum up, prostate cancer screening in men aged 75 and older is a complex issue that requires a careful and informed approach. It’s essential for healthcare providers and patients to continually reassess updated guidelines and research, engage in honest conversations about potential risks and benefits, and commit to making informed decisions based on each person’s unique circumstances. By doing so, they can ensure that elderly men receive the most appropriate and beneficial healthcare without unnecessary testing or treatment.