Data detail 'downstream' outcomes post-PCa screening

April 15, 2013

New research on the downstream outcomes following PSA screening may help inform individualized decisions among older men considering screening.

New research on the downstream outcomes following PSA screening may help inform individualized decisions among older men considering screening.

Researchers from the San Francisco Veterans Affairs Medical Center and colleagues sought to quantify 5-year downstream outcomes following an abnormal PSA screening result of 4.0 ng/mL or more in older men.

As reported online in JAMA Internal Medicine (April 15, 2013), a total of 295,645 men 65 years or older who underwent screening in the VA health care system in 2003 and were followed up for 5 years using national VA and Medicare data participated in the study. Among men whose index screening PSA level exceeded 4.0 ng/mL, researchers determined the number who underwent prostate biopsy, were diagnosed as having prostate cancer, were treated for prostate cancer, and were treated for prostate cancer and were alive at 5 years according to baseline characteristics.

A total of 25,208 men (8.5%) had an index PSA level above 4.0 ng/mL. During the 5-year follow-up period, 8,313 men (33%) underwent at least one prostate biopsy, and 5,220 men (62.8%) who underwent prostate biopsy were diagnosed as having prostate cancer, of whom 4,284 (82.1%) were treated for the disease. Performance of prostate biopsy decreased with advancing age and worsening comorbidity, whereas the percentage treated for biopsy-detected cancer exceeded 75% even among men 85 years or older, those with a Charlson-Deyo Comorbidity Index of 3 or higher, and those having low-risk cancer.

Among men with biopsy-detected cancer, the risk of death from non-prostate cancer causes increased with advancing age and worsening comorbidity, according to the authors, led by Louise C. Walter, MD.

"Performance of prostate biopsy is uncommon in older men with abnormal screening PSA levels and decreases with advancing age and worsening comorbidity," the authors wrote. "Understanding downstream outcomes in clinical practice should better inform individualized decisions among older men considering PSA screening."

The study was supported by a grant from the National Cancer Institute, National Institute on Aging, Veterans Affairs Career Development Award Program, and the New Mexico Veterans Affairs Health Care System.

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