Physicians order prostate-specific antigen (PSA) tests for many reasons: to confirm the presence of suspected cancer, to monitor progression of prostate cancer or the effect of treatment, or to predict the likelihood that prostate cancer will occur in the future (ie, screening). In this issue of JAMA, Walter et al1 document that many clinicians in the Veterans Affairs medical system order PSA tests for elderly male patients. In 2003, 56% of men older than 70 years who had no previous history of prostate cancer, elevated PSA level, or prostate cancer symptoms had a PSA test performed. Among men older than 85 years, 34% of those in good health and 36% in poor health had a PSA test performed. Most guidelines do not recommend PSA testing in elderly men, so why would physicians perform these screening tests? Why does practice not comply with policy?
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