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• PSA test at Mayo Clinic

The risks associated with a PSA test are related to what's done in response to the information you get from the test. In other words, will the benefit of knowing the results of a PSA test outweigh the potential risk of knowing?

Expected benefit
It seems that any test indicating whether you may have cancer would be beneficial. Indeed, a PSA test can often detect prostate cancer at an early stage.

But to judge the benefit of the PSA test, you need to know the answer to the following question: Do early detection and early treatment improve treatment outcomes and decrease the number of deaths from prostate cancer? Two recent large studies have produced somewhat competing answers, leading many experts to argue that there isn't enough evidence to answer this question.

A key issue is the typical course of prostate cancer. If all cases of prostate cancer progressed rapidly and caused poor health and death, then early detection would clearly be a good thing. However, prostate cancer usually progresses slowly over many years, and the majority of cases are diagnosed in men over the age of 65. Therefore, a man may have prostate cancer that never causes symptoms or never becomes a medical problem.

Limitations of the test
The limitations of the PSA test make it difficult to judge the benefit and risk of getting the test. These limitations include:

• PSA-raising factors. Other conditions that can raise PSA levels include an enlarged prostate (benign prostatic hyperplasia, or BPH) and an inflamed or infected prostate (prostatitis). Also, PSA levels normally increase with age.
• PSA-lowering factors. Men who are obese tend to have lower PSA levels. Medications to treat BPH and some dietary supplements taken for prostate health can lower PSA levels. These factors, therefore, may mask the presence of cancer.
• False-positives. Getting a positive result on a PSA test — a PSA level high enough to suggest you may have cancer — doesn't mean you have cancer. About 75 percent of men who get a biopsy after a positive PSA test don't have cancer. These test results are called false-positives.
• False-negatives. Getting a negative result on a PSA test doesn't prove that you don't have cancer. Some men with negative results — low levels of PSA suggesting no cancer — will later be diagnosed with prostate cancer. If a test misses the presence of cancer, the result is called a false-negative.
• Overdiagnosis. Studies have estimated that between 29 and 44 percent of men with prostate cancer detected by PSA tests have tumors that wouldn't result in symptoms during their lifetimes. These symptom-free tumors are considered overdiagnoses — identification of cancer not likely to cause poor health or to present a risk to the person's life.

Potential risks
The potential risks of the PSA test are related to results of the test and the choices you make based on those results. All of the variables related to prostate cancer and PSA test results contribute to the following risks:

• Treatment side effects. Possible side effects of treatments for prostate cancer include an inability to get or maintain an erection (erectile dysfunction), inability to control urine flow (urinary incontinence), problems with bowel movements, and death. These risks may seem acceptable if you know untreated disease would cause severe illness or death. But it's difficult to decide whether these risks are worth taking — whether the treatment does more harm than good — if prostate cancer is detected very early, when its future course is often unknown.
• Biopsy issues. A biopsy is an expensive, invasive procedure that has its own risks, including pain.
• Psychological effects. False-positive test results — high PSA levels but no cancer found with biopsy — can produce a significant amount of anxiety or distress. You may worry about whether the PSA test or the biopsy was correct. If you are diagnosed with prostate cancer but it appears to be a slow-growing tumor that doesn't result in illness, you may experience anxiety just knowing it's there.

Recommendations
A number of organizations have published guidelines for PSA testing. Recommendations by professional organizations and government agencies include the following:

• The U.S. Preventive Services Task Force concludes that the current evidence is insufficient to assess the benefits and risks of PSA testing to screen for prostate cancer in men younger than 75. It also recommends that screening shouldn't be done with men age 75 and older. The Centers for Disease Control and Prevention (CDC) and other U.S. government agencies follow these guidelines.
• The American College of Preventive Medicine recommends that for men age 50 or older who are expected to live at least 10 years, doctors provide information about the benefits and risks of screening and the limits of current evidence about the value of early testing and treatment. The organization also recommends that doctors help men make their own choices about screening.
• The American Cancer Society doesn't support routine PSA tests for prostate cancer. It does recommend that doctors discuss the benefits and risks of PSA testing with men who are age 50 and expected to live at least 10 years. It recommends earlier discussions for men in high-risk groups — men with a family history of prostate cancer and African-American men.
• The American Urological Association believes that doctors should offer a baseline PSA test to men at age 40. How often the PSA test should be repeated depends on the results of the baseline PSA test. The association also recommends that doctors discuss the benefits and risks with their patients.

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