VA hospitals not following PSA guidelines for elderly

Veterans Affairs hospitals screen elderly men with limited life expectancies for prostate cancer at surprisingly high rates, even though guidelines recommend against such screening, according to a recent study.

"Some VA hospitals are screening up to four-fifths of their very ill, very elderly patients, and some as few as one quarter, but none are targeting screening according to the men’s life expectancy," said principal investigator Louise C. Walter, MD, of the San Francisco VA Medical Center and the University of California, San Francisco.

The study of 622,262 men at 104 VA medical centers around the country was published online in the Journal of General Internal Medicine (Dec. 17, 2011). The authors found that, nationally, an average of 45% of men over age 85 years or with four or more serious diseases were given a PSA test. Screening rates at individual medical centers ranged from 25% to 79%.

"The screening rate you would expect to see for men with limited life expectancy is 0% to 20%," Dr. Walter said. "No medical center we looked at was in that category."

The authors found that healthy older men with longer life expectancies were screened at the same rates as frail, ill men.

"Low or high, a hospital’s screening rate had nothing to do with whether the men were sick or well," Dr. Walter said. "As geriatricians well know, some elders are quite healthy and might benefit from screening, while others are quite ill and will not. Decisions about screening and other medical procedures for older patients need to be made on an individual basis."

Dr. Walter pointed out that recent draft recommendations from the U.S. Preventive Services Task Force recommend that men age 75 years or older should not be given the PSA test because the harms outweigh the benefits.

The authors recommend new interventions at VA medical centers to reduce inappropriate PSA screening in elderly men, as well as new communication tools to help elderly men weigh the benefits and harms of screening.

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