National trends in prostate cancer screening among older American men with limited 9‐year life expectancies: Evidence of an increased need for shared decision making

BACKGROUND Prostate‐specific antigen (PSA) screening for prostate cancer remains controversial. Most groups recommend informed decision making for men with 10 years of remaining life expectancy. The primary objective of this observational cohort study was to investigate the association between predicted 9‐year mortality and prostate cancer screening among American men aged ≥65 years in 2005 and 2010. The second objective was to analyze the proportions of men who discussed screening with their physicians. METHODS Data were extracted from the 2005 and 2010 National Health Interview Surveys. Men aged ≥65 years without prostate cancer were divided into predicted 9‐year mortality quartiles. The proportions of men confirming a screening PSA within the prior year were determined. Logistic regression was used to compare screening rates. RESULTS Screening rates for men aged ≥65 years were 48% in 2005 and 48% in 2010 (P = .9). Men ages 65 to 74 years who had 75% predicted 9‐year mortality. Approximately 55% of screened men aged ≥75 years who had ≥53% predicted 9‐year mortality recalled discussing the advantages of screening, whereas 25% recalled discussing the disadvantages. CONCLUSIONS Prostate cancer screening with PSA did not differ significantly between 2005 and 2010 for men aged ≥65 years based on predicted 9‐year mortality. Approximately 33% of older men with a high likelihood of 9‐year mortality were screened despite minimal clinical benefit. Twice as many men recalled discussing the potential advantages of screening compared with the disadvantages. Cancer 2014;120:1491–1498. © 2014 American Cancer Society. Prostate cancer screening patterns in the United States in 2005 and 2010 demonstrate that many older, less healthy American men with limited life expectancies are being inappropriately screened for prostate cancer despite a very low likelihood of meaningful clinical benefit. This study demonstrates that, based on patients' self‐reported conversations with physicians, many men are being screened for prostate cancer without participating in an informed decision‐making process.