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Most authorities, even those that recommend prostate cancer screening, agree that screening does not make sense for elderly men whose life expectancy is less than 10 years. That's because these men are much more likely to die from a cause other than slowly progressive prostate cancer. Yet more than 20 percent of prostate biopsies, usually done as a followup to abnormal prostate-specific antigen (PSA) tests, are being done on this group, according to a recent study that was supported by the Agency for Healthcare Research and Quality (HS08397).
These men are very unlikely to benefit from the biopsy or subsequent treatment. In fact, 40 percent of men with limited life expectancy will die or be hospitalized within the year following biopsy. Doctors should clearly communicate to these men that a PSA test and prostate biopsy are very unlikely to be helpful to them, suggests Michael J. Barry, M.D., of Massachusetts General Hospital, principal investigator of the Prostatic Diseases Patient Outcomes Research Team (PORT-II) project.
Dr. Barry and his colleagues examined a 5 percent sample of Medicare claims for 1993 through 1997 for use of prostate biopsy in men aged 65 and older, who had no known history of prostate cancer. They found that 22 percent of those who underwent a prostate biopsy had a limited life expectancy (80 years or older or age 65-79 with a coexisting condition). This corresponded to a rate of 1,420 biopsies per 100,000 men, compared with a rate of 2,360 per 100,000 men with a life expectancy of 10 years or more (age 65-79 without coexisting conditions). This biopsy rate did not change substantially between 1993 and 1997.
Men with limited life expectancies were less likely to undergo prostate cancer treatments and more likely to be hospitalized after biopsy. In the year after biopsy, 1.6 percent of these men had radical prostatectomy, 2.3 percent had external-beam radiation, and 39 percent were hospitalized compared with 9.2 percent, 3.6 percent, and 24 percent, respectively, of men with greater life expectancy. Rates of transurethral resection of the prostate were similar for both groups (5.5 vs. 5.1 percent).
See "Prostate biopsies in men with limited life expectancy," by John H. Wasson, M.D., Thomas A. Bubolz, Ph.D., Grace Lu Yao, Ph.D., and Dr. Barry, in the May 2002 Effective Clinical Practice 5(3), pp. 137-142.
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