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PSA Screenings Not Always Appropriate (summer 2008)

If you’re a man age 50 or over, your doctor may talk to you about having a Prostate-Specific Antigen (PSA) screening, which measures the levels of a protein produced by the prostate.  Because PSA is present in both benign and cancerous prostate cells, it’s not specific only to prostate cancer.  Although the likelihood of cancer increases with greater elevations in PSA, abnormal levels of 4 to 10 nanograms per milliliter does not always mean cancer; it could mean inflammation or enlargement of the prostate.

Opinions vary on whether or not men should have a routine PSA test.  The American Cancer Society recommends that doctors offer the tests to men age 50 and older who expect to live another 10 years, and test men at high risk if they’re age 45 and older.  However, the Centers for Disease Control and Prevention (CDC) advises that it is not clear if the benefits of PSA screening outweigh the risks of follow-up treatments and that it’s not yet clear whether  PSA tests save lives. 

Before you get a PSA test, weigh the following:

• Your health:  do you have another condition or do you have a life expectancy of less than 10 years?  Because prostate cancer typically grows very slowly, you may not need PSA testing if you fall into one of these categories.
• Your demographics and lifestyle:  what is your age, race, and family history and do you maintain a healthy diet? Approximately 70 percent of diagnosed prostate cancers are found in men age 65 years or older.  African American men and those with a close family member, such as a father or brother with prostate cancer have a higher risk of the disease.  Eating a high-fat diet and being obese also increases your risk of prostate cancer.  Earlier detected prostate cancer is easier to treat.
• Prostate cancer isn’t necessarily deadly.  It’s often slow growing and most men diagnosed with prostate cancer die of another cause:  17% of men will be diagnosed with prostate cancer in their lifetime and only 3% will die of it, according to the Mayo Clinic.
• Widespread screening can result in false positives and unnecessary biopsies.  Treatment for prostate cancer can have serious risks and side effects, including urinary incontinence, erectile dysfunction or bowel dysfunction.
• Your point of view:  would you rather know or not know that you have prostate cancer?  Having the test can provide reassurance and, if you have prostate cancer, you can have it treated.

Researchers are working on better alternatives to PSA testing, but in the meantime, talk to your doctor about what’s right for you.  Also check with your health plan to find out whether routine PSA screening is covered by your plan.