Prostate blood tests of questionable value, study says

WASHINGTON — Millions of dollars are spent annually to monitor prostate health in men over 75 even though research shows little benefit in screening such men for prostate cancer, a study says.

"There is no evidence that screening men of this age would be beneficial to them, so this may not be the best use of health care resources," said Dr. Siu-Long Yao, a genital-urinary oncologist at the Cancer Institute of New Jersey in New Brunswick, N.J. He was senior author of the study appearing this week in the Journal of the National Cancer Institute.

"If you take all elderly men who die and do an autopsy, 30 to 70 percent will have prostate cancer, but they died of something else," said Yao. "Diagnosing the prostate cancer may lead to unnecessary complications in elderly patients who are more likely to die of something else, such as cardiovascular disease."

However, Dr. Richard G. Middleton, chairman of urology at the University of Utah Medical School and a contributor to the prostate cancer guidelines for the American Urological Association, said the study was "too simplistic."

"A routine PSA (Prostate Specific Antigen test) in a man over 75 would ordinarily not be necessary," but the blood test would be useful for a man with a history of prostate problems, he said.

"There are many situations where the PSAs are helpful in monitoring and following an elderly man," said Middleton. "I object to the idea that it was somehow bad form to order a PSA on an elderly patient."

Middleton said PSAs are needed to monitor for the recurrence of tumors in elderly men who have had surgery or radiation for prostate cancer earlier in life. PSAs also are appropriate, he said, for elderly men who have a suspicious-looking prostate on examination, who have a known tumor, or who have a previous history of an elevated PSA count.

In a survey of 7,889 men, researchers found that 32.5 percent of men over 75 received PSA blood tests, an estimated 1.5 million men a year.

Medicare typically pays $25.70 for the lab work, federal officials said, suggesting that more than $38 million is spent on those tests.

The PSA test does not detect cancer directly. Instead, it determines, in effect, if a patient has too much prostate tissue. That excess tissue can be caused by inflammation, by enlargement common to older men, or by cancer. A positive PSA test has to be followed up with a biopsy or other procedures before cancer can be confirmed.