# Why Doctors No Longer Recommend Routine PSA Testing After Age 70 **Prepared by:** Pedro Cheung MD **Last Updated:** May 2026 > **This handout is for educational purposes.** Every person is different. If you have questions about your own health, please speak with your doctor. --- ## What Is PSA, and Why Did Doctors Use to Test for It? PSA stands for **Prostate-Specific Antigen** — a protein made by the prostate gland. For decades, doctors measured PSA levels in the blood as a way to screen for early prostate cancer, hoping to find it before symptoms appeared. The idea made sense on the surface: catch cancer early, treat it, save lives. But after many large scientific studies, we now know that for men **70 and older**, the risks of PSA screening almost always outweigh the benefits. This is not a controversial opinion — it is the official recommendation of the nation's top medical authority on preventive care. --- ## What Do the Official Guidelines Say? The **U.S. Preventive Services Task Force (USPSTF)** — an independent group of medical experts that advises doctors on preventive care — reviewed all the available evidence and issued a **Grade D recommendation** against PSA screening for men aged 70 and older.[^1] A Grade D recommendation means: _"The potential harms are greater than the benefits. Routine screening should not be done."_ This is the same grade assigned to things like routine chest X-rays for non-smokers — tests that are more likely to cause harm than to help. --- ## The Three Core Problems With PSA Testing After 70 ### Problem 1: Most Prostate Cancers Found in Older Men Won't Kill Them This is the single most important fact to understand. **Prostate cancer is extremely common in older men — but most of these cancers grow so slowly that they never cause harm.** Autopsy studies have found that up to 80% of men over 80 had prostate cancer cells in their body at the time of death _from something else entirely_ — heart disease, stroke, pneumonia, or natural causes.[^2] Think of it this way: **most older men die _with_ prostate cancer, not _from_ it.** The USPSTF found that the **median age of death from prostate cancer is 80 years** — the same age at which many men are already managing heart disease, diabetes, arthritis, and other serious conditions.[^1] A 2024 study published in _Translational Andrology and Urology_ followed 204 men with conservatively managed prostate cancer (median age 73) for over 12 years. Only **9.3%** died of prostate cancer, while **41.2%** died of other causes. Age over 75 was one of the strongest predictors of dying from something _other than_ prostate cancer.[^3] > **What this means for you:** If a PSA test finds cancer in a 72-year-old man with diabetes, high blood pressure, and heart disease, the odds are high that another illness will affect his life first. Treating that cancer with surgery or radiation puts him through serious risks without adding years to his life. --- ### Problem 2: The PSA Test Has a Very High False-Positive Rate The PSA test is not a cancer test — it is a prostate irritation test. Many things besides cancer cause PSA to rise, including: - **Benign prostatic hyperplasia (BPH)** — an enlarged prostate, which is extremely common in older men - **Prostatitis** — prostate inflammation or infection - **Recent sexual activity** or a recent digital rectal exam - **Certain medications**, cycling, or even sitting for long periods Because of this, **approximately 75% of PSA results that are elevated do NOT indicate cancer** — they are false positives.[^4] For every 1,000 older men screened with PSA:[^1] |Outcome|Approximate Number of Men| |---|---| |False-positive result (no cancer)|~200–300| |Called back for follow-up testing|~200+| |Undergo prostate biopsy (invasive)|~100+| |Diagnosed with cancer that will never harm them|~20–50| |Prevented prostate cancer death|**0 (no benefit shown in men 70+)**| A false-positive result is not harmless. It causes: - **Anxiety and psychological distress** for the patient and his family - **A prostate biopsy** — a procedure with its own risks (see below) - **Repeat PSA monitoring** — sometimes for years — creating ongoing worry --- ### Problem 3: The Downstream Harms Are Serious and Often Permanent #### The Biopsy Risk If a PSA test is elevated, the next step is usually a **prostate biopsy** — inserting needles into the prostate through the rectum to collect tissue samples. This is an invasive procedure with real complications, especially in older men.[^5] A systematic review published in _Epidemiology and Infection_ covering over **162,000 patients** found:[^6] - Hospitalization after biopsy: **~1.1%** of patients - Sepsis (life-threatening blood infection): **~0.8%** after transrectal biopsy - Urinary retention requiring catheter: **~1–4%** of patients For an older man already on blood thinners, with a weakened immune system, or with heart disease, a post-biopsy infection can be far more dangerous than in a younger person. --- #### The Treatment Risk — When Cancer Is Found Perhaps the most troubling problem: **when cancer IS found, older men are frequently treated — even for slow-growing cancers that may never cause symptoms.** A large SEER-Medicare study found that among men aged 70+ who were diagnosed with **low- or intermediate-risk** prostate cancer (the kind least likely to be harmful), **77% received treatment within 6 months** — surgery, radiation, or hormone therapy. Men who had been tested more frequently were **3.57 times more likely** to receive treatment than untested men.[^7] These treatments carry heavy costs: **Surgery (Radical Prostatectomy):** - Approximately **1 in 5 men** develop **long-term urinary incontinence** (leaking urine, needing pads)[^1] - Approximately **2 in 3 men** develop **long-term erectile dysfunction**[^1] - Surgical risks (bleeding, anesthesia complications, clots) are higher in older men **Radiation Therapy:** - Can cause **bowel problems** including rectal bleeding, urgency, and diarrhea - Can also cause **urinary problems** and **erectile dysfunction** - Long-term effects accumulate over years **Hormone Therapy (Androgen Deprivation Therapy):** - Causes **osteoporosis** (bone thinning), increasing fracture risk - Causes **hot flashes**, fatigue, and mood changes - Increases **cardiovascular risk** — a major concern in older men who often already have heart disease > **The painful irony:** An otherwise healthy 73-year-old man may get a PSA test, be found to have a low-grade, slow-growing cancer, undergo prostatectomy, and spend the rest of his life wearing adult diapers and unable to have sex — for a cancer that likely would never have harmed him. --- ## What Does the Research Actually Show? ### The USPSTF Evidence Review (2018) The most comprehensive U.S. analysis, published in _JAMA_, reviewed data from multiple large randomized trials. For men aged 70 and older, it found:[^1] - **No reduction in all-cause mortality** from PSA screening - **No evidence of benefit** in preventing prostate cancer deaths in this age group - **Moderate-to-high harms** from false positives, biopsies, and treatment side effects The conclusion: _"The potential benefits of PSA-based screening for prostate cancer in men 70 years and older do not outweigh the expected harms."_ --- ### The European ERSPC Trial The European Randomised Study of Screening for Prostate Cancer — one of the largest prostate cancer screening trials ever conducted — confirmed that the benefit-to-harm ratio worsens significantly with increasing age, and specifically recommended **stopping screening at older ages** to prevent overdiagnosis.[^8] The ERSPC found that even in the group most likely to benefit (ages 55–69), you had to screen **1,000 men for 13 years** to prevent just **1.3 prostate cancer deaths**. In men over 70, no benefit was demonstrated. --- ### What Happens When Older Men Are Tested More Often? Shao and colleagues analyzed Medicare data on men aged 70+ and found that those with the **most PSA tests (4–6 tests over 5 years)** were:[^7] - 75% diagnosed with low- or intermediate-risk cancer (the kind unlikely to cause harm) - **3.57 times more likely** to receive treatment than men who were never tested - **78% more likely** to receive treatment even when they had low-risk cancer More testing → more diagnoses → more treatment → more harm. For older men, this chain of events rarely improves or extends life. --- ## What Should Men Over 70 Do Instead? ### If You Have No Symptoms - **Talk to your doctor** about whether PSA testing makes sense for you personally. There may be rare exceptions for men in exceptional health with very long life expectancy. - **Focus on what we know helps:** managing blood pressure, cholesterol, blood sugar, staying physically active, not smoking, and maintaining a healthy weight — these are proven life-extenders for older men. ### If You Already Have a Known Elevated PSA or a Prior Prostate Cancer Diagnosis - This handout is about **screening** (testing healthy men with no symptoms). If you already have a diagnosis or are being monitored, your situation is different. Continue to follow your doctor's guidance. ### If You Have Symptoms - **Urinary symptoms** (difficulty urinating, frequent nighttime urination, weak stream, blood in urine) should always be evaluated — not with PSA, but with a thorough exam. These symptoms are far more often caused by an enlarged prostate (BPH) or prostatitis than by cancer. ### Questions to Ask Your Doctor If your doctor offers a PSA test and you are over 70, it's reasonable to ask: 1. _"Given my age and health, what are the realistic chances this test would help me live longer?"_ 2. _"If the result is high, what would we do next — and what are the risks of those steps?"_ 3. _"Could a false-positive result lead me toward treatments I don't need?"_ 4. _"What are the most likely causes of my death over the next 10 years, and is prostate cancer one of them?"_ --- ## A Simple Summary: The Numbers That Matter |Question|Answer| |---|---| |How common is prostate cancer in men 70+?|Very common — but most cases are slow-growing and never become dangerous| |What is the median age of death _from_ prostate cancer?|80 years — meaning it competes with many other serious illnesses in older men| |What fraction of elevated PSA tests are false positives?|Approximately 75%| |Does PSA screening reduce death from prostate cancer in men 70+?|No — no benefit has been demonstrated in randomized trials| |What are the risks of treatment if cancer is found?|~20% chance of lifelong urinary leakage; ~67% chance of erectile dysfunction after surgery| |What do major medical guidelines say?|USPSTF: Grade D — do not screen men 70 and older| --- ## Bottom Line Your doctor is not ignoring prostate cancer when they recommend against PSA testing after age 70. They are following the best available science to protect you from tests, procedures, and treatments that are far more likely to **reduce your quality of life** than to extend it. **Knowing about a cancer that was never going to hurt you — and then treating it — is not a victory. It is a harm.** The goal of good medical care is not to find every abnormality. It is to help you live as long and as well as possible. For men over 70, that goal is far better served by managing the conditions most likely to affect your health, staying active, and spending your time enjoying life — not in follow-up appointments, biopsies, and recovery rooms. --- ## References [^1]: Grossman DC, Curry SJ, Owens DK, et al. (USPSTF). Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement. _JAMA._ 2018;319(18):1901–1913. [https://doi.org/10.1001/jama.2018.3710](https://doi.org/10.1001/jama.2018.3710) _(Retrieved from PubMed, PMID 29801017)_ [^2]: Stangelberger A, Waldert M, Djavan B. Prostate cancer in elderly men. _Rev Urol._ 2008;10(2):111–119. _(Retrieved from PubMed, PMID 18660852)_ [^3]: Chin JLJ, Tan YG, Low AWX, et al. Unravelling the natural history of localised prostate cancer in the post-PSA era: implications for clinical management. _Transl Androl Urol._ 2024;13(11):2459–2467. [https://doi.org/10.21037/tau-24-322](https://doi.org/10.21037/tau-24-322) _(Retrieved from PubMed, PMID 39698559)_ [^4]: American Academy of Family Physicians. PSA Screening for Prostate Cancer. _Am Fam Physician._ 2015. [https://www.aafp.org/pubs/afp/issues/2015/0501/od3.html](https://www.aafp.org/pubs/afp/issues/2015/0501/od3.html) _(False-positive rates cited as approximately 75%)_ [^5]: Mate K, Nedjim S, Bellucci S, et al. Prostate biopsy approach and complication rates. _Oncol Lett._ 2023;26(3):375. [https://doi.org/10.3892/ol.2023.13959](https://doi.org/10.3892/ol.2023.13959) _(Retrieved from PubMed, PMID 37559580)_ [^6]: Bennett HY, Roberts MJ, Doi SAR, Gardiner RA. The global burden of major infectious complications following prostate biopsy. _Epidemiol Infect._ 2016;144(8):1784–1791. [https://doi.org/10.1017/S0950268815002885](https://doi.org/10.1017/S0950268815002885) _(Retrieved from PubMed, PMID 26645476; systematic review of 162,577 patients)_ [^7]: Shao Y-H, Albertsen PC, Shih W, Roberts CB, Lu-Yao GL. The impact of PSA testing frequency on prostate cancer incidence and treatment in older men. _Prostate Cancer Prostatic Dis._ 2011;14(4):332–339. [https://doi.org/10.1038/pcan.2011.29](https://doi.org/10.1038/pcan.2011.29) _(Retrieved from PubMed, PMID 21709691)_ [^8]: Heijnsdijk EAM, Bangma CH, Borràs JM, et al. Summary statement on screening for prostate cancer in Europe (ERSPC). _Int J Cancer._ 2018;142(4):741–746. [https://doi.org/10.1002/ijc.31102](https://doi.org/10.1002/ijc.31102) _(Retrieved from PubMed, PMID 29023685)_ --- _This handout was prepared using evidence-based sources including PubMed-indexed peer-reviewed literature and guidelines from the U.S. Preventive Services Task Force. For full guideline text, visit [www.uspreventiveservicestaskforce.org](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening)._