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Prostate cancer screening: Should you get a PSA test?
Digital rectal examination
PSA tests aren't the only screening tool for prostate cancer. Digital rectal examination (DRE) is another important way to evaluate the prostate and look for signs of cancer. Your doctor performs the test by inserting a gloved, lubricated finger into your rectum to feel the prostate for bumps or other abnormalities. It's a quick, safe and easy test for your doctor to do. In addition to checking for signs of prostate cancer, a digital rectal exam may also reveal signs of rectal cancer. A DRE should always be done with a PSA test when screening for prostate cancer. This will help minimize the risk of missing prostate cancer — or wrongly identifying a benign prostate abnormality as cancer.
Simple test, not-so-simple decision
Because there are no clear answers on who should have PSA screening, consider the pros and cons of the test.
| Pros of PSA screening | Cons of PSA screening |
|---|---|
| PSA screening may help you detect prostate cancer early. | Many prostate cancers are slow growing and never spread beyond the prostate gland. |
| PSA testing can be done with a simple, widely available blood test. |
PSA tests can't tell the difference between prostate cancer and other noncancerous prostate conditions, such as infection (prostatitis) or benign prostate enlargement (BPH). Thinking you have cancer when you don't can cause stress and worry — as well as unnecessary and potentially risky follow-up tests. On the other hand, PSA tests don't always reveal prostate cancer when it's present. In some cases, false reassurance from normal PSA results (a false-negative) can actually delay a diagnosis of prostate cancer that needs treatment. |
| For some men, knowing is better than not knowing. Having the test can provide you with a certain amount of reassurance — either that you probably don't have prostate cancer or that you do have it and can now have it treated. | You may end up with a diagnosis of prostate cancer that is not a threat to your health and doesn't require treatment. This can cause anxiety and unnecessary testing with risks of pain, bleeding and infection. |
| Cancer is easier to treat and is more likely to be cured if it's diagnosed in the early stages of the disease. | Not all prostate cancers need treatment. Treatment for prostate cancer can have serious risks and side effects, including urinary incontinence, erectile dysfunction or bowel dysfunction. |
| The number of deaths from prostate cancer has gone down since PSA testing became available. | There is no clear evidence that the decrease in deaths from prostate cancer is due to early detection and treatment based on PSA or due to other factors. In fact, in numerous studies, men who get screened have not been shown to live longer than men who don't. |
Think about your risk factors for prostate cancer
Knowing the risk factors for prostate cancer can help you determine if and when you want to begin prostate cancer screening. The main risk factors include:
- Age. As you get older, your risk of prostate cancer increases. After age 50, your chance of having prostate cancer increases substantially. The majority of prostate cancers are found in men age 65 years or older. The option to have PSA testing begins at age 40 and continues until you're at the age when your life expectancy is 10 years or fewer. Once you reach that age, the likelihood that a prostate cancer would progress and cause problems during the remainder of your lifetime is small. In fact, the U.S. Preventive Services Task Force does not recommend prostate cancer screening in men 75 and older.
- Ethnic background. For reasons that aren't well understood, black men have a higher risk of developing and dying of prostate cancer.
- Family history. If a close family member — your father or brother — has prostate cancer, your risk of the disease is greater than that of the average American man.
- Diet. A high-fat diet and obesity may increase your risk of prostate cancer.
Consider the varying viewpoints: What are the recommendations?
| Organization | Recommendation |
|---|---|
| American Urological Association (AUA) | The AUA encourages men who expect to live another 10 years to have a baseline PSA test at age 40. How often the PSA test should be repeated depends on the results of the baseline test. |
| American Cancer Society (ACS) | The ACS recommends that doctors offer the test 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. |
| Centers for Disease Control and Prevention (CDC) | The CDC considers the evidence insufficient to determine whether the benefits outweigh the harms. |
| U.S. Preventive Services Task Force (USPSTF) | The USPSTF does not recommend prostate cancer screening in men 75 and older, or in men who will probably live 10 years or fewer. For men under 75, the USPSTF considers the evidence insufficient to determine whether the benefits outweigh the harms. |
| American College of Preventive Medicine (ACPM) | The ACPM recommends that a man decide about whether to have PSA testing after discussing the risks and benefits with his doctor. The ACPM considers the need for screening questionable in elderly men with other chronic illnesses and men with life expectancies of less than 10 years. |
How does it add up?
A positive PSA test can be a lifesaver for some men, identifying prostate cancer that needs treatment early. It's generally a good idea to have PSA testing done if you're at increased risk of prostate cancer. However, not all men need to have the screening. You may want to think twice if you're in a group of men unlikely to benefit from it. After considering the pros and cons of screening, your age, general health and risk factors, your preferences and what the experts say, talk to your doctor. Together you can make the right decision for you.
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