What is prostate cancer?
Prostate cancer is the
abnormal growth of cells in the tissues of the
prostate gland . It is the most common cancer in men. Most men who get it are
older than 65.
Unlike many other cancers, it is usually
slow-growing. Most men will die with prostate cancer but
not of prostate cancer.2 This
does not mean that you will get it. Each person is different, and tests cannot
show who will get prostate cancer and who won't.
cancer usually does not cause symptoms. When prostate cancer is diagnosed
early, before it has spread outside the prostate gland, it may be cured with
radiation or surgery to remove the prostate. As prostate cancer grows or
spreads, symptoms may develop, including urinary problems (such as blood in the
urine) and bone pain.
If your father, brother, or son has had
prostate cancer, you have a higher-than-average chance of getting the
disease.3 Men whose families carry the gene changes
that cause breast cancer, BRCA1 or BRCA2, are thought to be at increased risk
for prostate cancer.4 African-American men have higher
rates of prostate cancer and are more than twice as likely to die from it as
men in other racial and ethnic groups in the United States.4
While PSA testing can find cancers earlier, and
research studies show that men who have cancer now live longer, these extra
years may just be from finding the cancer earlier. And there may be a decrease
in the quality of life after cancer treatment, from the side effects of
What is the prostate-specific antigen test?
prostate-specific antigen (PSA) test is a blood test. PSA is released into a
man's blood by the cells that make up the prostate gland. Low amounts of PSA
may be found in the blood of healthy men. The amount of PSA in the blood
normally increases as a man's prostate enlarges with age. It also increases
after ejaculation and after trauma to the prostate caused by such things as a
long bike ride. It is also increased by inflammation of the prostate gland
(prostatitis) and by prostate cancer.
PSA test is usually done along with a digital rectal exam. Together they can
help identify men who may have prostate cancer and should consider further
How does age affect the decision to have a PSA test?
Your chance of getting prostate cancer increases as you age. Men who are
younger than 50 and men who are between ages 50 and 70 who do not have serious
health problems may gain the most from early detection and treatment.
After reviewing research on routine screening for prostate cancer using
the PSA test, the
U.S. Preventive Services Task Force (USPSTF)
recommends the following:5
- Men age 75 and older should not be screened
for prostate cancer.
- Men younger than 75 should talk with a doctor
about the pros and cons of PSA testing before being tested. Men younger than 75
with long-term medical problems or who are expected to live less than 10 years
are unlikely to benefit from screening.
Your chance of getting prostate cancer increases as you
age. Men who are younger than 75 and who do not have serious health problems
may gain the most from early detection and treatment.
What kind of results can a PSA test show?
PSA result can be the first warning sign of prostate cancer. A high PSA can
signal a higher risk of getting prostate cancer in the future.6 But a high PSA can also be linked to other causes that are
The amount of PSA in the blood normally increases as
a man's prostate enlarges with age. But the PSA level increases more over time
in men who have prostate cancer than in men who do not.
- A PSA level below 1.0 ng/mL means a very low risk for prostate
cancer. In one large study, no men with this low of a PSA developed prostate
cancer in the next 3 years. So, retesting 3 years later is likely to be a safe
- A PSA of 1.5 ng/mL is low, but a
small number of men at 1.5 get prostate cancer within the next few years.
Experts say it is best to retest your PSA every year if it is over 1.5 ng/mL.
- Your doctor will tell you if you need more tests based on your age
and how your PSA has changed over time. More testing can tell you if the high
PSA is caused by cancer or by something else, like an enlarged prostate or a
The PSA test and digital rectal exam can suggest a
problem when there is not one (false-positive result). Only about 20%
to 30% of men who have a PSA test result greater than 4.0 ng/mL actually have
prostate cancer. These tests may also fail to detect a problem when there is
one (false-negative result). One study found that 15% of
men who have a PSA level of 4.0 or less developed prostate cancer.7
What the PSA test does not tell you
naturally enlarges as a man gets older. More than half of all men who are older
than 50 have an enlarged prostate. Prostate enlargement affects the PSA level,
making it less accurate as a cancer screening.
other things can make a PSA level go up-for example, ejaculation or an
infection in the prostate-your doctor may recommend that you have another PSA
test later before you make any further decisions.
If your PSA test
suggests that you may have prostate cancer, your doctor may recommend a
biopsy, which is the only way to confirm the presence
of prostate cancer. If the biopsy confirms cancer, you must decide how or
whether to treat it.
A few prostate cancers grow rapidly. Men who
have fast-growing cancers are more likely to die from prostate cancer than men
who have slower-growing cancers. A PSA test cannot accurately predict which
type of prostate cancer a man has. But in men who have not been diagnosed with
prostate cancer, a PSA velocity test can measure how
rapidly PSA levels increase over time. The PSA velocity test checks the rate of
change in PSA levels over a 2- to 3-year period. PSA levels increase more
rapidly in men with prostate cancer and more slowly in men with prostate
What do the experts recommend?
disagree on whether men age 50 or older should routinely have PSA tests to
screen for prostate cancer. They do agree that men should be given the pros and
cons of PSA testing so that they can make their own decisions.
Some experts worry that PSA testing for prostate cancer begins a process
that can force a man to make difficult decisions and can lead to other health
problems that are caused by the treatment for prostate cancer. Studies continue
to evaluate the effectiveness of PSA tests.
- The American Cancer Society recommends that
if you are in good health and have a life expectancy of at least 10 years, you
should be offered annual screening tests beginning at age 50.
American Cancer Society and the American Urologic Association recommend
screening if you are an African-American man who is older than 45.
The American Cancer Society recommends screening even earlier-starting at 40-if
you have several close relatives who developed prostate cancer before age
- Some medical groups are more cautious. They recommend that
doctors discuss the pros and cons of PSA tests with men who are considering
screening and then make decisions based on the man’s needs.
U.S. Preventive Services Task Force (USPSTF)
recommends that men age 75 and older should not be screened for prostate cancer
and that younger men should discuss the pros and cons of PSA testing before
being tested. The USPSTF also states that men younger than 75 with long-term
medical problems or who expect to live less than 10 years are unlikely to
benefit from screening.
- Some medical groups such as the American
Academy of Family Physicians, the U.S. National Cancer Institute, the U.S.
Centers for Disease Control and Prevention, and others do not recommend routine
testing for prostate cancer.
For more information, see the topic