Conflicting recommendations on prostate cancer screening have left some men confused about PSA tests. In this Expert’s Corner video, UMass Medical School urologist Jennifer Yates, MD, discusses what men and their doctors should consider when deciding whether to test.
“The patient needs to be educated about ‘What is a PSA?’ and ‘What is it going to indicate?’” said Dr. Yates, assistant professor of urology and director of minimally invasive urologic surgery at UMass Memorial Medical Center. “Understanding the PSA test is not the greatest test for prostate cancer is the first step.”
PSA test results can be misleading. It's possible for PSA levels to be elevated when cancer isn't present, and not elevated when it is. Findings of elevated levels may be followed by a biopsy, an invasive procedure which causes pain, lost time from daily activities and risk of infection. Even when cancer is present, it may be so slow-growing that it will never require treatment. Despite this, many men will choose treatment over uncertainty.
The inherent uncertainty of PSA tests may explain why recommendations from reputable medical organizations vary in terms of who to test and when. For example, the United States Preventive Services Task Force says no men should undergo routine PSA testing because the risks outweigh the benefits. The American Urological Association’s recommends all men between the ages of 55 and 70 consider, in consultation with their doctors, commencing an ongoing PSA screening program. However, the AUA advises against PSA screening for men who are older than 70, or have less than a 10- to 15-year life expectancy.
All this still doesn’t mean that younger men should never be tested with the PSA test. “If they have a strong family history of prostate cancer, if they have some sort of symptoms or signs or any other evidence that makes us suspicious, it doesn’t mean we’re prohibited from doing a PSA on these patients,” Yates noted.
In addition to a man’s age, other factors to consider when deciding for or against PSA testing is family history of prostate cancer, evidence of prostate gland enlargement or inflammation, and any emotional and lifestyle concerns.
The takeaway from all the recommendations, according to Yates, is that, “Men between the ages of 55 and 69 are the ones who stand to benefit the most from PSA screening.” And even then, a decision needs to be made based on each individual’s risk factors and personal preferences
“The most important aspect we can emphasize is that we don’t just check PSA as a routine,” Yates said.
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