For the first time, a US expert panel has come out in favour of an age restriction for the early detection of prostate carcinoma. The guidelines of the U.S. Preventive Services Task Force in the Annals of Internal Medicine … (2008; 149: 185-191) state that men aged 75 and older should no longer be offered a PSA test.
In the previous version of the guideline, it had been said that a PSA test does not make sense with a life expectancy of less than ten years, since the patients are then very unlikely to experience the final stage of prostate carcinoma. However, since the individual life span is not predictable, this recommendation had no influence on early detection.
More than half of all 75- to 79-year-olds in the USA have a PSA test every year. Whether fewer will do so as a result of the new guidelines remains to be seen, as the Task Force is not the only expert body. The American Cancer Society and the American Urological Association have so far stuck to the old recommendation, and Medicare reportedly wants to continue to reimburse older men for the test.
In no other country are so many prostate cancers diagnosed as in the USA. Last year, 218,000 men were diagnosed with prostate cancer. Experts believe that 29 to 44 per cent are overdiagnoses in older men who will not live to see the tumour progress.
Comment by Dr Keul:
A very interesting approach that was also discussed in the plenary session at the penultimate AUA Congress in 2007 (annual congress of the American Urological Association). Here, even a limitation to 65 years was discussed.
Due to the much more frequent use of the PSA test in America and the very strict biopsy recommendation to immediately perform a transrectal prostate biopsy at a PSA value above 4.0 ng/ml, earlier and less advanced tumour stages are detected and treated in the USA than in Europe.