The Prostate Specific Antigen test, or PSA, is a test many men are used to getting at their annual exams. This test is meant to assist in screening for prostate cancer. However, its use has been scrutinized for many years. In 2013 new guidelines for PSA testing were released by the American Urological Association. They recommend that testing be done every two years for men 55-69 years of age, rather than every year. In addition, men with a 9-year mortality risk of 52% due to other causes should not be screened.
Why not get tested? There are many reasons. First we need to understand the usual course of prostate cancer. Prostate cancer is very common. In fact, it is the most common non-skin cancer affecting 1 in 7 men over a lifetime. Most patients experience no symptoms from prostate cancer, meaning it is often found when patients have complaints due to other conditions such as Benign Prostatic Hyperplasia (BPH), or from routine PSA screenings.
The majority of prostate cancers are very slow growing. Sixty percent of prostate cancers grow so slowly that the patient is likely to die from heart disease or other causes before the prostate cancer causes problems.
Second, up to 13% of men will have a false positive result, meaning the test is positive, but the patient does not have prostate cancer. For example, the PSA can be elevated in conditions such as prostatitis (inflammation of the prostate) or BPH which is exceedingly common in this patient population.
Third, there is no set PSA level that confirms the diagnosis of cancer. False positive results may lead to unnecessary biopsies which are invasive and not without risk and complications including urinary incontinence and erectile dysfunction. Finally, there is no way to tell which patients will die from prostate cancer and which patients will die with prostate cancer. This leaves many patients with a final diagnosis of prostate cancer with the difficult task of deciding what to do about it.
For these reasons some are pushing for even more lenient screening guidelines than every two years. One suggestion is that patients get a “baseline” PSA. There is 3.5% risk of developing prostate cancer within 10 years when the PSA is
We suggest that all men educate themselves, know their family history of prostate cancer, think about what they would do if diagnosed with prostate cancer and talk to their doctor about the risks and benefits of prostate cancer screening.
Editor’s note: This article is only for informational purposes. For any medical issues, please consult your own physician.
(Dr. Alok K. Gupta is an Internist, a doctor for adults. He is a Board Certified in Internal Medicine. He completed his residency in Internal Medicine at Salem Hospital in Salem, Massachusetts. Part of the training was also at Massachusetts General Hospital. Dr. Gupta has been practicing Internal Medicine since 1998. He was in upstate New York for six years. Recently, he had been practicing in Manassas, and now is in practice in Gainesville. He has privileges at Prince William Hospital. Dr. Gupta is an outstanding physician. He is well known as a compassionate and caring physician.)