Public survey and survival data do not support recommendations to discontinue prostate-specific antigen screening in men at age 75.
OBJECTIVE
To evaluate the US Preventative Services Task Force (USPSTF) recommendation to discontinue prostate-specific antigen (PSA) screening at age 75.


METHODS
Public survey: A cohort of 340 patients was surveyed at our PSA screening clinic and stratified by awareness of the recommendation and education level. Age (< 75, >or= 75), race, health insurance status, knowledge of prostate cancer, and opinion on screening discontinuation at age 75 was evaluated between groups. Disease risk and survival analysis: A cohort of 4196 men who underwent radical prostatectomy between 1988 and 2008 was stratified into age groups: < 65, 65-74, and >or= 75. Associations between clinicopathologic variables, disease risk, and survival were compared between age groups using univariate and multivariate analysis.


RESULTS
Approximately 78% of men surveyed disagreed with the USPSTF recommendation. The number of men who disagreed was not significantly different between awareness groups (P = .962). Awareness of new screening guidelines showed a significant difference (P = .006) between education groups. Age >or= 75 years was predictive of high-risk disease based on D'Amico's criteria (odds ratio = 2.72, P = .003). Kaplan-Meier and Cox regression analyses showed an association of men aged >or= 75 years with higher rate of PSA recurrence, distant metastasis, and disease specific death compared with the age groups of < 65 and 65-74 (P <.05).


CONCLUSIONS
Men presenting to our PSA screening clinic disagreed with discontinuation of screening at age 75. Men aged >or= 75 years had higher risk disease and poorer survival. The USPSTF recommendation was supported neither by public opinion nor disease risk and survival results.
Caire
Arthur A
AA
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Sun
Leon
L
Robertson
Cary N
CN
Polascik
Thomas J
TJ
Maloney
Kelly E
KE
George
Daniel J
DJ
Price
Marva M
MM
Stackhouse
Danielle A
DA
Lack
Benjamin D
BD
Albala
David M
DM
Moul
Judd W
JW
D000367:Age Factors; D000368:Aged; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000401:mortality*; D011639:Public Opinion; D011795:Surveys and Questionnaires; D015996:Survival Rate
D017430:Prostate-Specific Antigen