UroToday - PSA screening is recommended for men up to an age when their life expectancy drops below 10 years. As such, it is generally uncommon to use PSA screening in men over age 75, as the average American man lives to age 76. How often older men get PSA testing, is not well reported.

In the August 2006 issue of the Journal of Urology, Dr. Scales and associates at Duke University report that 14% of all PSA tests are performed in man older than 75 years.

Data for the analysis was acquired between 1999 and 2002 from the National Center for Health Statistics probability survey. Almost all medical specialties are represented and a total of 101,148 records from 5,197 physicians are included for years 1999-2002. The data are used to estimate the use of ambulatory care services in the US. The database obtains probability samples from geographic primary sampling, physician practices in each unit and visits in each physician practice.

A total of 14,554 visits to primary care physicians (non-urologists) and urologists were analyzed. The average patient age was 62 years and 18% were by men older than 75 years and 60% were by men ages 50-75 years. There were 41.8 million PSA tests represented and 74% were performed in men ages 50-75 years, 12% were performed in men ages 40-49 years and 14% were performed in men older than 75 years.

The population based PSA testing rates per age group were 6%, 26% and 28% for age groups 40-49, 50-75, and greater than 75 years. In 2002 the population based screening rate in men greater than 75 years was 34%.

The majority of PSA tests (76%) were performed by non-urologists with urologists performing 24%. In men greater than age 75 years, non-urologists and urologists performed 70% and 30% of PSA tests, respectively.

A laboratory facility on site was associated with a higher likelihood of PSA testing (OR 1.36) but physician employment status (owner vs. employee) was not. Race was not associated with PSA testing in older men. What is unknown is whether tests were performed for PSA screening or monitoring for treated prostate cancer or BPH.

By Christopher P. Evans, M.D.

J Urol 2006;176:511-514
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