title: National trends in prostate cancer screening among older American men with limited 9-year life expectancies: evidence of an increased need for shared decision making.
abstract: BACKGROUND
  Prostate-specific antigen (PSA) screening for prostate cancer remains controversial. Most groups recommend informed decision making for men with 10 years of remaining life expectancy. The primary objective of this observational cohort study was to investigate the association between predicted 9-year mortality and prostate cancer screening among American men aged ≥65 years in 2005 and 2010. The second objective was to analyze the proportions of men who discussed screening with their physicians.
  
  
  METHODS
  Data were extracted from the 2005 and 2010 National Health Interview Surveys. Men aged ≥65 years without prostate cancer were divided into predicted 9-year mortality quartiles. The proportions of men confirming a screening PSA within the prior year were determined. Logistic regression was used to compare screening rates.
  
  
  RESULTS
  Screening rates for men aged ≥65 years were 48% in 2005 and 48% in 2010 (P = .9). Men ages 65 to 74 years who had <27% predicted 9-year mortality were most commonly screened, with 56% screened in 2010, compared with 34% of men aged ≥75 years with >75% predicted 9-year mortality. Approximately 55% of screened men aged ≥75 years who had ≥53% predicted 9-year mortality recalled discussing the advantages of screening, whereas 25% recalled discussing the disadvantages.
  
  
  CONCLUSIONS
  Prostate cancer screening with PSA did not differ significantly between 2005 and 2010 for men aged ≥65 years based on predicted 9-year mortality. Approximately 33% of older men with a high likelihood of 9-year mortality were screened despite minimal clinical benefit. Twice as many men recalled discussing the potential advantages of screening compared with the disadvantages. Cancer 2014;120:1491-1498. © 2014 American Cancer Society.
authors: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors: Michael W
authors: MW
authors: Drazer
authors: Sandip M
authors: SM
authors: Prasad
authors: Dezheng
authors: D
authors: Huo
authors: Mara A
authors: MA
authors: Schonberg
authors: William
authors: W
authors: Dale
authors: Russell Z
authors: RZ
authors: Szmulewitz
authors: Scott E
authors: SE
authors: Eggener
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D015992:Body Mass Index; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003657:Decision Making; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards*; D006304:Health Status; D006801:Humans; D008017:Life Expectancy; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: guidelines; life expectancy; mortality; prostate cancer screening