Screening for Prostate Cancer
- PSA Screening – A simple blood test, the PSA screening measures the concentration of prostate-specific antigen (PSA), a protein produced by the prostate gland.
- While there is a correlation between elevated PSA and prostate cancer, other conditions can also raise PSA levels. These include an enlarged prostate, prostatitis, and advancing age. In fact, studies have shown that about 75% of men with an elevated PSA do not have prostate cancer. To determine which men actually have cancer and which don’t, physicians traditionally perform a biopsy. While undergoing a diagnostic biopsy isn’t as traumatic as surgery, the procedure does cause discomfort, provoke anxiety, and has resulted in serious health complications.
- Rather than subject all men with elevated PSA’s to biopsies, many primary care physicians and urologists order a test called the “free PSA” for patients with a total PSA level between 4 ng/ml and 10 ng/ml. or for those whose recent PSA scores have shown a significant upward velocity. Studies have shown that men with a total PSA in this range and a free PSA greater than 25% are more likely to have a benign condition than to have cancer, making a biopsy unnecessary. But those men with a total PSA in the same range and a free PSA below 10% would likely need to undergo a biopsy since statistics show that they more likely than not to have prostate cancer.
Who should get a PSA screening?
The American Cancer Society recommends the following PSA screening guidelines:
- Men age 50-69 who are at average risk for the disease
- Men who are 45 years of age or older and are African-American
- Men who are 40 years of age or older with at least one first-degree relative (father, brother, or son) who has been diagnosed with prostate cancer.
Note: Screening recommendations for prostate cancer vary among physicians and healthcare organizations. Please consult with your physician.
How often should I get a PSA Screening?
Recommended testing intervals can vary among physicians and healthcare institutions, as well as being dictated by a patient’s risk factors. But we do advocate that men adhere to their follow-up testing appointments, given that a continuous rise in PSA level may be a sign of prostate cancer, even at levels lower than the 4.0 ng/mL level often used as the threshold for “elevated.”
Please consult with your physician regarding frequency and type of testing best suited for you or your family member/friend.
How do I prepare for a PSA Screening?
- There is no fasting required in preparation for the blood test used for a PSA screening.
- There is near-unanimous agreement within the healthcare community that all men consenting to PSA testing should first be informed in detail about the number of false-positive and false-negative test results, as well as the PSA level variance from test to test for reasons unrelated to prostate cancer. Also, men should be made aware of the medical community’s (and the government’s) concern about serious side effects that have resulted from the aggressive treatment of cancers that are slow-moving, non-symptomatic, and non-life threatening.