Should You Have a PSA Test?

There’s controversy, but doctors say it’s still the best way to detect prostate cancer early

Prostate cancer kills 30,000 men each year. So prostate cancer specialists like Joseph Trapasso, M.D., recommend a yearly screening for men over age 50, and men age 40+ who are African-American or have a family history of the disease. The simple test detects PSA (prostate-specific antigen) in the bloodstream.

If your PSA level is above 4, your doctor probably will suggest a biopsy, a 15-minute outpatient procedure that removes tissue samples from the prostate for further testing. But chances are three out of four that the biopsy won’t find cancer. That’s because other common conditions, like prostate enlargement or infection, also can raise PSA levels.

Even if your doctor finds you have prostate cancer, in most cases it will not have spread or caused problems yet. “PSA tests can detect cancer at its earliest, most treatable stages,” says Trapasso, a urologic oncologist at Lehigh Valley Hospital and Health Network. “The question is how many insignificant cancers we are diagnosing that might not need therapy.”

To make things even more controversial, studies have found that 15 percent of men with significant prostate cancer have PSA levels below 4. Some medical experts now suggest you get a biopsy if your PSA level is above 2.5. “That could lead to more men having biopsies with a large majority not having cancer,” says Trapasso's colleague, internist Matthew Winas, D.O.

Does PSA testing make sense or not? Some doctors feel it is still the best available screening tool for prostate cancer. It’s most useful when your doctor also does a digital rectal exam and measures how quickly your PSA level rises over time. If the level rises more than 0.75 in a year, it may be a sign that cancer has developed.

In summary, Trapasso and Winas say: “Have a yearly PSA test and rectal exam, and discuss the results with your doctor so you can make informed decisions about the need for further testing and treatment.”

Want to Know More about your PSA levels and how they change as you age? Click here.

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