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decision pointShould I have a prostate-specific antigen (PSA) test to screen for prostate cancer?

The prostate-specific antigen (PSA) test is a blood test that is used to screen for prostate cancer. Many men who are older than 50 have this test, along with a digital rectal exam, as part of their regular checkups. But experts disagree on whether PSA testing should be recommended for all men.

If you are thinking about having a PSA test, consider the following risks and benefits of screening.

  • There are other causes of a high PSA level besides prostate cancer. After receiving a high PSA result, it is common to have more testing and then find that cancer is not the cause.
  • Prostate cancers that are found early tend to be curable.
  • Prostate cancer usually grows slowly. In some cases, it never affects a man's health.
  • Sometimes prostate cancer grows or spreads quickly. Unless it is treated, it leads to death.
  • Treatment for prostate cancer can cause serious side effects, including loss of bladder control and not being able to have an erection. (In many cases these problems improve within a year.1)
  • After an abnormal PSA test, your next choice is to have a biopsy to look for signs of prostate cancer. If you learn that you have cancer, you then make choices about treatment.
  • If you have a family history of prostate cancer, your risk of getting it is higher than average.

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.

Early prostate 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 treatment.

What is the prostate-specific antigen test?

The 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.

The 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 tests.

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?

A high 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 not cancer.

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 choice.6
  • 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 prostate infection.

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

The prostate 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.

Because several 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 enlargement.

What do the experts recommend?

Medical experts 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.
  • The 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 65.
  • 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.
  • The 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 Prostate Cancer.

Your choices are:

  • Have a PSA test to screen for prostate cancer.
  • Do not have a PSA test to screen for prostate cancer.

The decision about whether to have a PSA test takes into account your personal feelings and the medical facts.

Making a decision about PSA testing
Reasons to have a PSA test Reasons not to have a PSA test
  • A PSA test can help detect prostate cancer early, while it is small and usually curable.
  • Undetected prostate cancer may grow and spread into other tissues. Prostate cancer that has spread often cannot be cured.
  • Men in their 50s and 60s who are in good health may benefit from testing for and then treating prostate cancer.
  • When PSA tests are done yearly for several years in a row, they are helpful tools to monitor any changes in your PSA level.

Are there other reasons you might want to have a PSA test?

  • Prostate cancer often grows slowly and may never cause symptoms.
  • PSA test results may be inconclusive and may require further testing.
  • A PSA test may begin a process that can lead you to difficult decisions about further testing and treatment.
  • Testing could lead to cancer treatment that can cause other health problems, especially loss of bladder control and not being able to have an erection.
  • Your life expectancy is less than 10 years, and you may not realize the benefit of treatment.

Are there other reasons you might not want to have a PSA test?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having a PSA test. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I'm only in my early 50s and want to find out now, while I'm in excellent health, if I have cancer in my prostate.

Yes No NA*

This cancer is usually a slow-growing cancer and is not likely to get very far in my lifetime. So I have no need to know whether I have prostate cancer.

Yes No Unsure

My health is not so good, and I'm not sure I am up to pursuing cancer testing and treatment.

Yes No Unsure

It is important for me to know if I have cancer, even if it is early and not causing symptoms yet.

Yes No Unsure

A PSA test may not be a good screening test for me because I have an enlarged prostate and am aware that my PSA levels will always be higher than normal.

Yes No NA

I am concerned that I might end up with urinary and erection problems if I have prostate cancer treatment.

Yes No Unsure

There's a history of prostate cancer in my family, and I will do anything I can to avoid having this cancer.

Yes No NA

If my PSA is high, I am willing to have additional testing to determine whether I have prostate cancer.

Yes No Unsure

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have a PSA test.

Check the box below that represents your overall impression about your decision.

Leaning toward having a PSA test

 

Leaning toward NOT having a PSA test

         
  • Prostate Cancer
  • Prostate-Specific Antigen (PSA)

Citations

  1. Eastham JA, Scardino PT (2002). Radical prostatectomy. In PC Walsh et al., eds., Campbell's Urology, 8th ed., vol. 4, pp. 3080–3106. Philadelphia: W.B. Saunders.

  2. Frankel S, et al. (2003). Screening for prostate cancer. Lancet, 361(9363): 1122–1128.

  3. American Cancer Society (2006). Cancer Facts and Figures 2006, pp. 1–56. Atlanta: American Cancer Society. Available online: http://www.cancer.org/docroot/STT/stt_0.asp.

  4. National Institutes of Health (2007). Prostate cancer genetics: Fact sheet. Available online: http://www.nih.gov/about/researchresultsforthepublic.

  5. Lin K, et al. (2008). Benefits and harms of prostate-specific antigen screening for prostate cancer: An evidence update for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 149(3): 192-199.

  6. Aus G, et al. (2005). Individualized screening interval for prostate cancer based on prostate-specific antigen level. Archives of Internal Medicine, 165(16): 1857–1861.

  7. Thompson IM, et al. (2004). Prevalence of prostate cancer among men with a prostate-specific antigen level less than or equal to 4.0 ng per milliliter. New England Journal of Medicine, 350(22): 2239–2246.

Author Kerry V. Cooke
Editor Sydney Youngerman-Cole, RN, BSN, RNC
Associate Editor Tracy Landauer
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer J. Curtis Nickel, MD, FRCSC - Urology
Last Updated October 9, 2009

WebMD Medical Reference from Healthwise

Last Updated: October 09, 2009
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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