To PSA or Not to PSA?

By Howard Frey, M.D., Medical Director, The Valley Hospital Urologic Oncology Center

PSA is a protein produced by cells of the prostate gland. The PSA – prostate-specific antigen – test measures the level of PSA in a man’s blood. An elevated PSA level can be indicative of prostate cancer. Until recently, many doctors and professional organizations encouraged yearly PSA screening for men beginning at age 50. Some organizations recommended that men who are at higher risk of prostate cancer, including African American men and men whose father or brother had prostate cancer, begin screening at age 40 or 45.

The PSA test has now come under scrutiny because routine screening may lead to unnecessary treatment for low-grade, non-aggressive prostate cancer. The U.S Preventive Services Task Force (USPSTF) – whose recommendations are made for primary care doctors –argues that the risks of treatment for low-grade cancers outweigh the benefits gleaned from screening. The American Urological Association (AUA)—comprised of urologists, the physicians that most commonly treat prostate cancer—strongly disagrees with the USPSTF’s recommendation.

No one argues that PSA testing is not an effective tool for finding prostate cancer. In fact, since the advent of routine PSA testing, the death rate from prostate cancer has dropped 40 percent. However, many men diagnosed with prostate cancer will have a slow-growing form of the disease that will not cause any problems over the course of their lifetime and does not require treatment. For them, in fact, any intervention may cause more harm than good. That is the crux of the USPSTF’s position – that routine PSA screening will result in too many patients needlessly undergoing treatment for prostate cancer that could cause them more harm than the disease itself. The AUA recommends active surveillance as a means to avoid needless treatment, with intervention if circumstances change.

On the other hand, when a patient has a more aggressive form of prostate cancer he should be treated without delay. Aggressive prostate cancer when undiagnosed and untreated can be life threatening.

Ultimately, whether you should or should not have a PSA test is something you will have to decide after discussing it with your doctor, after considering your overall risk factors and weighing your personal preferences.

Personally, I get a PSA test every year.

To learn more about the services provided by the Urologic Oncology Center, please visit www.ValleyFightsCancer.com.