A PSA on the PSA test: men, keep this in mind

May 09, 2018 | by Matthew Siegel, MD

Screening tests are important because they can detect potential diseases or health disorders in people without any sign of disease. But what if a screening test does more harm than good?

That’s been the debate about the prostate-specific antigen (PSA) test. The PSA test is a blood test primarily used to screen for prostate cancer. Doctors use the test to determine whether a man has elevated levels of PSA in his blood. High levels of PSA may indicate the presence of prostate cancer.

The PSA test was originally approved by the Federal Drug Administration in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease.

Until 2008, some doctors encouraged yearly PSA screenings for men beginning at age 50. Men at high risk of prostate cancer were recommended to have a PSA test even earlier.

So what’s the big deal about a PSA test? As researchers learn more about the potential benefits and harms of prostate cancer testing (and the consequences of over diagnosing), many organizations have begun to discourage the screening, saying it does more harm than good.

Here’s why: Prostate cancer is not an aggressive type of cancer and most men have a slow-growing form that isn’t fatal, even if left untreated. Many men with localized prostate cancer will never have problems. At the same time, prostate cancer treatment can have long-term and life-altering side effects.

Here’s where it gets confusing: A PSA test can detect prostate cancer early, but it may not save lives. It can also give false-positives or false-negatives, causing some men to have additional unnecessary invasive procedures and treatment that can result in urinary and sexual side effects.

To make matters more complicated: Just because a man has high levels of PSA in his blood, doesn’t mean he has prostate cancer. Other conditions can elevate PSA level, such as prostatitis. Also, there is no specific normal or abnormal levels of PSA in a man’s blood since PSA levels can vary over time in the same man.

It can’t all be negative, can it? It’s not. Prostate cancer screenings can help identify cancer early on. An abnormal PSA test and digital rectal exam, combined with further tests (e.g., prostate biopsy, transrectal ultrasound), can help determine whether you have prostate cancer.

So what are the new recommendations? The U.S. Preventative Services Task Force (USPSTF) recommends the decision to have a PSA test be between a man and his doctor, and doctors should only order the PSA test for older men between the ages of 55 to 69, after discussing its pros and cons.

Since prostate cancer does not have many signs and symptoms, especially in the early stages, it is important for you to have an open discussion with your doctor during your regular checkup.

All prostate cancers are not the same and testing for prostate cancer is often determined by your risk factors. You and your doctor should work together to make a decision that is right for you.

Join us on Wednesday, Sept. 26 for a "Prostate Cancer: What you should Know" Lunch & Learn at Elmhurst Hospital, as urologist Zuhair Hussaini, M.D., discusses risk factors, symptoms, screening and available treatments for prostate cancer. Register now.

Related blogs:

7 misconceptions about prostate cancer every man should know
5 questions men ask about prostate cancer


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