Many men wonder if they should get checked for prostate cancer with a blood test (the PSA blood test – “PSA = Prostate Specific Antigen”). This is a very complicated discussion. For most men, the PSA test is no longer recommended as a general screening test. However, if you have urinary symptoms or a family history of prostate cancer, the PSA test may be useful and you should check with your doctor to discuss this.
ABOUT PROSTATE CANCER
Prostate cancer is very common. Up to 50% of men in their 50s will have a tiny prostate cancer brewing inside of them. 90% of 90-year-olds will have a prostate cancer inside them! HOWEVER, most of these prostate cancers are slow-growing and often do not cause any harm. As sad as it is to say, most of these men end up dying from other more common causes such heart attacks, strokes, or other cancers. The prostate cancer will never really harm most of these men.
Studies show that, among men 55–69 who did not get screened with a PSA test, the risk of dying from prostate cancer after 13 years was 6 in 1,000. With regular PSA screening, the risk of dying from prostate cancer may be reduced to 5 in 1,000. That’s only 1 in 1000 lives saved, and 5 men still died despite getting screened!
THE HARMS OF PSA TESTING
You might ask, “Well, why not still do the PSA test in order to save 1 in 1000 lives?” The answer is because doing the PSA test can cause potential harm to men.
The PSA test is not a perfect test. It can come back high even when there is no actual prostate cancer. There are many other reasons that can cause a high PSA level besides cancer. If a man gets a PSA test that comes back high, that can cause anxiety and worry for that man. It can then lead to a number of other tests and specialist visits (including a prostate biopsy, which is quite painful and not without risk). Then, if the final results come back normal (NO prostate cancer), that man has just undergone all that needless worry, tests, and risks.
WHAT IF THE PSA TEST ACTUALLY FINDS A CANCER, THOUGH?
If a high PSA test leads to a prostate biopsy and that biopsy actually confirms a cancer, then that leads to more things to consider.
Having a surgery to remove the prostate cancer (a “prostatectomy”), carries up to a 45% chance risk the man will have trouble getting erections for the rest of his life (erectile dysfunction). It also carries up to a 20% risk the man will have long-term urinary incontinence afterwards. These are very significant risks for most men!
HERE IS A VERY IMPORTANT POINT: Knowing these risks, and knowing that most prostate cancers are slow-growing and may never affect them, many men will decide NOT to get their prostates removed. If that is the case, then why go looking for a prostate cancer in the first place!? (There is no point in even doing the PSA test to look for cancer, and undergo all the worry and tests, if your final answer will be NOT to get your prostate removed anyway!)
HERE is a picture that shows the risks versus benefits of PSA testing.
SO WHAT SHOULD YOU DO?
As you can see, this is a very complicated decision. Before deciding on getting a PSA test, you should think about the pros and cons of doing so. For most men, the recommendation is not do a PSA test, but there may be special reasons you may wish to do so.
HOWEVER, if you are having urinary symptoms, or have a family history of prostate cancer, you should see your doctor for further assessment and discussion.
If you are 70 years of age or older, you should generally NOT get the PSA test for screening (i.e. no symptoms, just screening for possible underlying prostate cancer without symptoms), because the risks of doing the test far outweigh the benefits.
WHAT ABOUT THE DIGITAL RECTAL EXAM?
The digital rectal exam (“the finger test”) is no longer recommended as screening tool for prostate cancer. Research showed it did not really make a difference. Click here for more information on this.
SCREENING vs. SYMPTOMS
All of the above information relates to “SCREENING” a population of people. That is, testing people who do NOT have any prostate or urinary symptoms to see they may have prostate cancer.
This is totally different and not applicable to men who HAVE SYMPTOMS. If you have prostate or urinary symptoms, the PSA blood test and/or a digital rectal exam may well be suggested and helpful.
SEE BELOW FOR AN EXCELLENT VIDEO EXPLAINING ALL OF THIS IN MORE DETAIL:
And here is short additional video that looks a little deeper at the PSA numbers: