Prostate Specific Antigen (PSA) is a type of protein released by prostate tissue that is found in higher levels in a man’s blood when there is abnormal activity in the prostate, including prostate cancer or a condition called benign prostate hyperplasia (BPH), which is not cancer but a noncancerous growth of normal prostate cells that occurs with age. Ever since higher levels of PSA have been linked to a higher likelihood of having prostate cancer, there has been hope that PSA testing could be a simple way to find prostate cancer earlier.
However, it is more complex than expected. The PSA test can be useful for finding early prostate cancer, which helps many men get the treatment they need before the cancer spreads. At the same time, not all men with prostate cancer have higher PSA levels, and PSA screening also finds conditions that are not cancer as well as very slow-growing prostate cancers that would never threaten a man’s life. Because of this, screening for prostate cancer may lead to some men having surgery, radiation therapy, and other treatments that may not ever really be needed. This is because these slow-growing, non-life threatening prostate cancers don’t really need treatment, particularly in men who are older than 75. Also, treatments can cause significant side effects, such as risk of infection, impotence (inability to get an erection), and incontinence (inability to control urine flow).
Research has shown that men who receive PSA screening are less likely to die specifically from prostate cancer. However, when considering all causes of death, men who receive PSA screening are not more likely to live longer than men who do not receive screening. This may seem somewhat confusing because it is obviously good to prevent deaths from prostate cancer. However, in research that compared PSA screening with simple routine observation, the men who received screening and the men who participated in routine observation had the same overall survival. This has not yet been explained, but it appears that the men who received screening had more deaths from other causes, such as strokes, heart attacks, and other conditions. As a result, there was no overall benefit to the men who received PSA screening. It is also important to note that this type of information is not yet available for black men or men with a family history of prostate cancer, which is why men in these two groups should carefully discuss PSA screening with their doctors.
ASCO recommends that men who have no symptoms of prostate cancer and are expected to live less than 10 years should not have PSA testing to screen for prostate cancer. As discussed above, this recommendation does not apply to black men, because of the limited research available for these men, or for men with a family history of the disease.
What this means for patients
Men who have other medical conditions that are expected to limit the length of their lives can avoid PSA testing. If you expect to live at least another 10 years, or are unsure if you should receive PSA testing, talk with your doctor to find out if the test is right for you. Every man should discuss his situation and risk of prostate cancer with his doctor to make a decision.
Questions to ask your doctor
- What is my risk of developing prostate cancer? How is it determined?
- Is PSA testing appropriate for me?
- What issues should I consider before making my decision?
- If I choose PSA testing, what are the next steps if I have a raised PSA level? How often should I be screened?
- How is PSA screening different if I am black or if I have a family history of prostate cancer?
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