Summary: Most cancer screening guidelines do not recommend screening elderly persons in poor health who have limited life expectancies because the harms of screening (which occur immediately) outweigh the potential benefits (which occur many years in the future). PSA screening rates among elderly men with limited life expectancies should be much lower than current practice to avoid harming these men with unnecessary tests and procedures. Guidelines should be more explicit about how life expectancy is defined and provide tools to help clinicians identify men with poor prognoses who are most likely to be harmed by PSA screening, considering both age and the presence of severe disease.
