Prostate cancer: no/incomplete PSA testing linked to high-risk disease in older men

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  • Almost half of older men undergoing radiotherapy for prostate cancer had no/incomplete prostate-specific antigen (PSA) testing. 
  • No/incomplete PSA testing was associated with high-risk disease.

Why this matters

  • Consider screening healthy older men who are likely to benefit from early detection and treatment.

Key results

  • 54.0% underwent PSA testing with appropriate follow-up biopsy, 26.3% underwent PSA testing without biopsy, and 19.7% received no PSA testing. 
  • Odds of PSA testing decreased by 20% with each additional year of age (P<.001). 
  • PSA testing rates did not significantly differ before vs after the 2008 US Preventive Services Task Force recommendations (P=.91). 
  • Men without PSA testing were more likely to be diagnosed with higher stage disease (P=.002). 
  • PSA-tested cohort was significantly more likely to be diagnosed with low-grade disease (Grade group [GG] 1; 42.6% vs 16.7%) and less likely to be diagnosed with high-grade disease (GG4-5; 19.0% vs 41.3%). 
  • 51.6% of untested men were diagnosed with high-risk disease vs 23.0% of tested men. 
  • Untested men had higher odds of being diagnosed with high-risk disease (OR, 3.39; P<.001).

Study design

  • Retrospective review of records from 1993 to 2014. 
  • Funding: None specified.


  • Lack of comorbidity data. 
  • Population derived from a tertiary referral center.