Experts Question Guidance on Prostate Cancer Screening After Age 70 Following President Biden's Diagnosis

Former President Joe Biden’s recent diagnosis with an aggressive form of prostate cancer has sparked renewed attention to the topics of prevention, detection, and the complexities surrounding screening guidelines for this common disease among men.

The U.S. Preventive Services Task Force (USPSTF) advises that men aged 55 to 69 make individualized decisions about prostate-specific antigen (PSA) screening in consultation with their healthcare providers. The USPSTF explicitly recommends men over age 70 forego routine prostate cancer screenings, citing a lack of evidence for meaningful benefit in this older population.

According to Dr. Shawn Dason, a urologic oncologist at The Ohio State University Comprehensive Cancer Center, while the USPSTF is a widely referenced resource, other organizations may suggest varying approaches. He emphasized the importance of shared decision-making for men in their 50s and 60s, noting, "They should engage in a discussion about the topic of prostate cancer and the role of PSA in screening — and the potential benefits and harms."

Screening Risks and Nuances
Dr. Dason explained that for men younger than 50 or older than 70, there is less agreement on whether to screen, due to significant risks such as:

• Over-diagnosis
• Over-treatment
• Unnecessary exposure to side effects

"In past decades, we didn't really have an understanding of the nuances about when prostate cancer should be treated and when [it] should just be observed in a protocol called ‘active surveillance,’" Dason noted. Over-treatment can result in persistent urinary, sexual, or bowel-related side effects, even if the cancer itself might never have caused harm.

It is now recognized that some prostate cancers are slow-growing and may not threaten life expectancy, especially for older patients, leading some experts to argue for a more cautious approach to aggressive intervention.

Controversy Over Screening Guidelines
Senior medical analyst Dr. Marc Siegel expressed concern about current recommendations, particularly the exclusion of routine PSA screening in men over 70. "Studies have shown that use of the PSA has fallen off in men over the age of 40 as a result of the USPSTF recommendation," he wrote, referencing over 300,000 new prostate cancer cases and upwards of 35,000 related deaths annually in the United States.

Dr. Siegel argued that advances in treatment have improved outcomes and quality of life, making the case for broader screening. "I am saying that all men over the age of 45 should have this screening. Period. Regardless of age," he stated.

However, Dr. Dason reminded that age alone should not determine screening eligibility. If a man is healthy and expected to live many more years, early detection could improve survival and quality of life. Conversely, those with significant health issues and limited life expectancy may experience more harm than benefit from screening and treatment.

Making Individual Decisions
Experts agree that men—especially those aged 55 to 69—should discuss PSA screening with their healthcare provider, weighing factors such as personal health status, family history, and risk tolerance. For men showing no symptoms but considered of average risk, Dason advised consideration of screening. The conversation changes significantly for those presenting symptoms, requiring prompt medical evaluation outside of routine screening protocols.

Key Takeaways:

• Prostate cancer screening remains a complex and individual decision.
• Men aged 55-69 are encouraged to discuss screening with their healthcare provider.
• Men over 70 should consider personal health and life expectancy before opting for or against screening.
• Both under- and over-treatment pose risks, making shared decision-making essential.

Dr. Dason concluded, "I would encourage men to think about their situation and have a conversation with their medical provider." As attention around Biden’s diagnosis continues, the broader debate over optimal prostate cancer screening practices is likely to persist.