Dear Doctors: I am 69 years old, in very good health and have a physical every year. Last year, my doctor of 20 years did not order a PSA test for prostate, even though it’s covered by Medicare. Is a PSA test for a man my age necessary? My doctor has also stopped EKGs and chest X-rays. I’m confused.
Dear Reader: You’re bumping up against two issues here. One pertains to PSA screenings in particular, and the other concerns preventive screening tests in general. Let’s take them in order.
For those who aren’t familiar, a PSA test measures blood levels of a certain protein known as prostate-specific antigen. It is produced by both normal and malignant cells in the prostate. While high levels of PSA circulating in the blood can suggest the presence of cancer, that’s not the only possible cause. Someone with an enlarged or inflamed prostate can also have a high result on a PSA test. Each of those changes to the prostate gland become increasingly common as men reach older age, and they can lead to a false positive test result for cancer. This, in turn, can open the door to unnecessary additional tests and procedures, including a biopsy of the prostate gland.
Due to the complexities of accurately assessing a high PSA result, guidance regarding the test has evolved. As of 2018, the United States Preventive Services Task Force recommends its use in men between the ages of 55 and 69 be based on professional judgment regarding each man’s risk factors, and also patient preference. The test is not recommended after age 70. Prostate cancer tends to grow slowly. When identified in older age, an approach known as active surveillance, in which low-risk cancers are closely monitored, is often recommended.
And this brings us to the topic of preventive health screening guidelines. They are set forth by the United States Preventive Services Task Force, an independent panel of 16 volunteers who have expertise in primary health care and preventive care. Among their mandates is the review of statistical data gathered in population-based health care studies, which follow large groups of people over the course of many years. The panel analyzes data collected in these studies. This includes preventive screening, onset of disease and outcomes. Using this detailed information, the panel assesses the efficacy of preventive health screening and proposes guidelines based on approaches that yielded the best results.
While these screening guidelines are useful, they are not the last word on the matter. In fact, some medical groups, including the American Cancer Society, sometimes disagree with the task force findings. When this occurs, they offer screening guidelines of their own. Not surprisingly, this leads to inconsistencies. The conflicting recommendations can leave patients not only confused, but at odds with their doctors.
In our own practices, we emphasize to our patients that screening guidelines are simply a tool, and not a set rule. Whether to move forward with any particular test is based on family and medical history, existing risk factors and input from the patients themselves.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
