Dear Doctors: If my doctor won’t order a PSA or other screening test, can I pay for it myself? We are always told about the importance of early detection. So why aren’t screening tests recommended for seniors?
A. A screening test is used to determine whether someone who is asymptomatic has developed a disease or condition. The aim is to identify a medical issue at an early stage, when treatment is more likely to result in a positive outcome. This could be curing the disease or managing it to improve longevity and quality of life.
Health data show these types of screenings can save and extend lives. But the guidelines for these tests are not hard and fast rules but recommendations based on the analysis of a complex range of scientific data.
How, when and by whom a screening test is used depends on the person. The decision takes into account general health, medical and family histories and age.
Older adults often live with health conditions that make treating a disease, such as cancer, its own health risk. In these cases, certain types of screening tests are recommended only when the potential benefits outweigh the potential harms.
The prostate-specific antigen test falls into that category. While effective at detecting certain hormonal changes that occur when someone has prostate cancer, it can return false positive results. The PSA test has been overused in the past, which has led to unnecessary, potentially harmful treatment.
The current recommendation for men between the ages of 55 and 69 is to decide on the use of a PSA test on a case-by-case basis. That means evaluating someone’s general health, risk for prostate cancer and ability to move forward with further testing and treatment if needed.
We recommend that Black men of all ages, who are at increased risk of developing prostate cancer, work with their doctors to tailor PSA testing to their specific needs.
It is possible to find a lab where you can order your own PSA test. But we think your energies are better spent looking for a different doctor. Find someone willing to let you share in these important health care decisions.
Dr. Eve Glazier and Dr. Elizabeth Ko are UCLA Health internists.
