Prostate Cancer Screening in Men 75 Years Old or Older: An Assessment of Self-Reported Health Status and Life Expectancy

Purpose: Opinions vary regarding the appropriate age at which to stop prostate specific antigen screening. Some groups recommend screening men with a greater than 10-year life expectancy while the United States Preventive Services Task Force recommends against screening men 75 years old or older. In this study we evaluated the influence of health status and life expectancy on prostate specific antigen screening in older men in the United States before the 2008 United States Preventive Services Task Force guidelines. Materials and Methods: The study cohort comprised 718 men age 75 years or older without a history of prostate cancer who responded to the 2005 National Health Interview Survey, representing an estimated 4.47 million noninstitutionalized men in the United States. Life expectancy was estimated from age and self-reported health status. Results: Overall 19% of the men were 85 years old or older and 27% reported fair or poor health. In the previous 2 years 52% had a prostate specific antigen screening test. After adjustment for age, race, education and physician access, men with fair or poor health were less likely to receive prostate specific antigen screening than those with excellent or very good health (adjusted OR 0.51, 95% CI 0.33-0.80, p = 0.003). Overall 42% of the men predicted to live less than 5 years and 65% of those predicted to live more than 10 years reported having recent prostate specific antigen screening. Conclusions: Before the United States Preventive Services Task Force recommendation, health status and life expectancy were used to select older men for prostate specific antigen screening. However, many men expected to live less than 5 years were screened. A strict age cutoff of 75 years reduces over screening but also prohibits screening in healthy older men with a long life expectancy who may benefit from screening.