About 40% of men over the age of 80 had regular PSA tests. An elevated PSA level may prompt a series of subsequent tests and treatments. This is because “‘cancer’ is an emotional term,” admitted Dr. Sartor. He said he still sees patients whose response to very low-risk cancer is “I want to end it now.”
However, treatment is associated with significant side effects that often subside in the first year or two, but can persist or even worsen. For example, data from the United Kingdom show that 5% of men treated with radiotherapy and 4% of men under active surveillance had more urine leakage requiring a pad six months after treatment. It affected about half of men who underwent resection.
After 6 years, 17% of the prostatectomy group still needed pads. Among those under active surveillance, it was 8 percent and 4 percent in the radiation group.
Similarly, men under active supervision were more likely to maintain erectile capacity, but all three groups reported decreased sexual function with age. They were twice as likely (12%) to report faecal leakage than men in the other groups.
The economic costs of unnecessary tests and treatments are also high, as an analysis of claims from the large Medicare Advantage program shows. This study, recently published in JAMA Network Open, investigated payment for regular PSA screening and related services in a man aged 70 years and older with a healthy prostate.
“Unnecessary initial screenings trigger these follow-up services, a chain of events catalyzed by anxiety,” said David Kim, a health economist at the University of Chicago and lead author of the study. The more you progress, the harder it will be to stop.”
From 2016 to 2018, for every $1 spent on PSA testing in men over 70, another $6 was spent on additional PSA testing, imaging, radiology and surgery.