Relevance of prostate-specific antigen screening in elderly individuals: A cross-sectional analysis from a tertiary care referral teaching hospital in India

Abstract

Background: Prostate-specific antigen (PSA) screening is a routine clinical practice in the geriatric clinical practice– often intended to pick up early cases of prostate cancer. Multiple studies done across the world have demonstrated population-specific normative values of PSA with varying thresholds for prostate cancer. Universal application of the normative values results in false-positive screening results thus leading to unnecessary apprehension and invasive follow-up for the same– often unnecessary. Objectives: a. To study the PSA values of geriatric patients and postulate the possible normal values of PSA in different age groups of elderly. b. To correlate the PSA values with biopsy reports, wherever available, thus hypothesising the acceptable limits of PSA, beyond which prostatic biopsy may be indicated. Methods: This was a retrospective, cross-sectional study done at Amrita Institute of Medical Sciences, Kochi, India, where PSA of patients registered for the Comprehensive Geriatric Health Checkup Package between January 2012 and June 2013 were studied (n = 1038). Results: a. 105 patients were found to have an elevated PSA, of which 24 underwent biopsy after serial estimations as per protocol. Only 7 were proven to be malignant. b. Mean PSA values were found to be 1.55, 1.4 and 1.20 in the 60–69 years, 70–79 years and 80+ categories, respectively. Conclusion: a. Age-specific ranges of PSA are essential in interpreting PSA of the elderly and our study showed values that are similar to the expected. b. The study also demonstrates that roughly 10% of the elderly population in all age subsets has PSA values over the normal. Routine PSA testing puts roughly 1 in 10 patients at risk for biopsy and also places them at risk of probably unnecessary worry about a possible prostatic malignancy. c. Only 7 malignancies were picked up by the routine use of PSA testing in the study population of 1038, i.e., 6.7/1000. This brings us to the question of the cost effectiveness and utility of routine PSA screening, particularly when it places roughly 10% at risk for biopsy. d. Malignancies were detected in patients with falling PSA values and also who had unsuspicious findings on PR, hence questioning its relevance.