Screening for prostate cancer-checking for signs of the disease when there are no symptoms-is done with the prostate-specific antigen (PSA) test. In the United States, about 16 out of 100 men will get prostate cancer, but only 3 will die because of it. That means about 97 out of 100 men will die of something other than prostate cancer.1
The number of deaths caused by prostate cancer has dropped over the past 20 years. The decrease has been linked to more cases of early diagnosis through PSA testing and to better cancer treatment. But it is not yet known if PSA testing actually saves lives or if the benefits of having PSA screening are worth the harms of follow-up tests and cancer treatments.
Finding prostate cancer early leads you to some big decisions. Most prostate cancer grows slowly. And the side effects of treatment may change your quality of life. It's possible that you may not be able to have an erection or control urination after surgery. These are important things to think about. If you are older with other serious health problems, these side effects may seem worse than early-stage cancer that may not grow much during your lifetime. But for active or younger men, treatment may help them live longer.
So before you decide to have a PSA test, talk with your doctor. Ask about your risk for prostate cancer, and discuss the pros and cons of testing. Some men will not want to live with the side effects of treatment. Other men are more concerned about survival. It is important to learn all you can and talk to your doctor before making a decision.
The U.S. Preventive Services Task Force (USPSTF) recommends against routine PSA tests to look for prostate cancer. The USPSTF found that testing does more harm than good. Men who are tested may end up getting treatment they don't need, and those treatments can cause other problems. Few, if any, men are helped to live longer by having the test.
Other expert groups, such as the American Cancer Society (ACS) and the American Urological Association (AUA), disagree.
- The American Cancer Society (ACS) advises men to talk with their doctors about testing and treatment before deciding about testing. The ACS says that men should not be tested without learning about the risks and benefits. The ACS advises talking to a doctor about testing:
- At age 50 for men who are at average risk of getting prostate cancer and are expected to live at least 10 more years.
- At age 45 for men at high risk, such as African Americans and men who have a first-degree relative (father, brother, or son) who had prostate cancer when he was younger than 65.
- At age 40 for men at an even higher risk, such as those with several first-degree relatives who had prostate cancer at an early age.
- Men who decide to have this test may only need to be retested every 2 years if their PSA is less than 2.5 nanograms per milliliter (ng/mL). But testing should be done yearly for men whose PSA is 2.5 ng/mL or higher.
- The American Urological Association (AUA) recommends that:
- Men under age 40 shouldn't have PSA screening.
- Men ages 40 to 54 who are at average risk shouldn't have routine PSA screening.
- Men ages 55 to 69 should talk with their doctors about having the test. Discuss the benefits and harms of PSA screening before deciding if you want the test. If you decide to have this test, having it every 2 years rather than every year may reduce the harms.
- Men ages 70 and older (or any man with less than a 10- to 15-year life expectancy) shouldn't have routine PSA screening.
For more information, see the topic Prostate Cancer.