Stacy Loeb, MD, MSc, PhD (Hon), discusses the nuances of prostate cancer screening

In a recent interview, Stacy Loeb, MD, MSc, PhD (Hon), a professor in the departments of urology and population health at NYU Grossman School of Medicine and Perlmutter Cancer Center in New York, New York, discussed the complexities surrounding prostate-specific antigen (PSA) screening guidelines for older men, using President Joseph R. Biden’s case to illustrate potential limitations of current protocols. She explains that although guidelines recommend stopping routine PSA screening around age 70 or 75 years due to the increased risk of harm over benefit at a population level, individual cases like Biden’s raise important concerns. Stopping screening at 72 may have delayed the detection of an aggressive prostate cancer. However, she emphasizes that continued screening is not without risks, such as false positives, unnecessary biopsies, complications, and overtreatment. For example, a man could have a borderline PSA level, undergo a biopsy, experience severe adverse events, and still not have cancer—highlighting the potential harms of continued testing.

Loeb stressed the importance of individualized decision-making based on life expectancy and overall health rather than age alone. She noted that some individuals in their 70s are remarkably healthy and active, with life expectancies that justify continued screening. She underscored the vast variability in aging and the need for personalized assessments. Moreover, she emphasized that patient preferences play a crucial role in screening decisions. Physicians should engage in shared decision-making, discussing the risks and benefits of screening and considering the patient’s values and concerns.

In summary, Loeb advocated for a more nuanced approach to PSA screening in older adults. Rather than applying age cut-offs rigidly, clinicians should consider individual health status, life expectancy, and personal preferences to guide decisions about prostate cancer screening.