{'fraction_non_alphanumeric': 0.0193756727664155, 'fraction_numerical': 0.02852529601722282, 'mean_word_length': 4.845911949685535, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Patient-Initiated Prostate Cancer Screening Among Older U.S. Men

TO THE EDITOR: We read the recent letter from Guo and He (1) with great interest and were particularly intrigued by their finding that patient-initiated screening increased in correlation with age. The authors limited their analysis to men aged 40 to 70 years for unclear reasons, especially because a large proportion of men older than 70 years are screened for prostate cancer. We recently reported that, in 2013, men aged 75 to 79 years were significantly more likely to be screened than men in their 50s and one third of men older than 75 years with less than 9 years of estimated remaining life expectancy were screened. Prostate cancer screening among men aged 75 years or older decreased from 44% in 2010 to 37% in 2013, but the reason for this persistently high rate of screening among older men is unclear (2). Therefore, it is important to understand why these men continue to be screened for prostate cancer despite a low likelihood of clinical benefit. Did Guo and He investigate patient-initiated screening among men aged 70 years or older in 2013? It would be intriguing to see what percentage of prostate-specific antigen (PSA) tests for men aged 70 years or older were ordered at the request of the patient and whether patient expectations inordinately explain these persistently high rates in light of our recent findings. One potential explanation may be testing momentum and patient expectations. We previously investigated the role of shared decision making in the 2010 National Health Interview Survey and found similarly low rates of patient-initiated screening. How these findings have changed in response to the 2012 U.S. Preventive Services Task Force statement universally discouraging prostate cancer screening with the PSA assay would be interesting to see (3, 4).