Pros and Cons of the PSA Screening Test for Prostate Cancer

After skin cancer, prostate cancer is the most common cancer affecting American men. The American Cancer Society estimates that 1 in 9 men will be diagnosed with prostate cancer. This year alone, 164,690 new cases of prostate cancer will be diagnosed.

Prostate cancer is a serious disease—and is the second leading cause of cancer death for American men (behind lung cancer). However, most men who are diagnosed with prostate cancer don’t die from it. That’s because in most cases, prostate cancer grows very slowly, and you can live with it for years if not decades without symptoms.

Of course, as with all cancers, the sooner detected and treated, the better the outcome. That’s why we offer mammograms and PAP tests for women to detect cancers that may not yet show symptoms. For men, the PSA blood test is used the same way, but because of the nature of prostate cancer and the reliability of the test, it’s important to weigh the pros and cons on how useful the test is.

Understanding Prostate Cancer

Prostate cancer is an abnormal growth of cells that occurs in a man’s prostate gland. This gland is located below the bladder and makes some of the fluid seen in semen.

While the exact cause of prostate cancer isn’t known, risk factors include:

• Age—the risk increases after age 50.
• Ethnicity—more African-American men and Caribbean men of African descent develop prostate cancer than men from other ethnicities. Asian-American men and Hispanic/Latino men are less likely to develop prostate cancer, but the reasons for this disparity are unknown.
• Geography—people living in North America, Europe, Australia, and the Caribbean islands are more at risk than those who live elsewhere.
• Family history—prostate cancer can run in families, but it also can occur when no family history of the disease exists.

Symptoms of prostate cancer include:

• Pain when urinating
• Trouble urinating
• Blood in the urine

But keep in mind that these symptoms don’t always mean prostate cancer. If you notice any of these problems, talk with your doctor.

The PSA Test

PSA stands for prostate-specific antigen, a screening blood test. For years, it was used as the go-to screening test for prostate cancer, until recent studies showed it’s not always the most reliable test for this purpose. Why? In some cases, a high PSA score can yield a false positive—indicating cancer where there is none and resulting in additional testing. At the same time, a low score could yield a false negative, missing some cancers.  Plus, most men as they get older will have areas of cancer in their prostate, but most of these men will never even know they have the cancer and are more likely to die from other causes.

Challenges in Detecting Prostate Cancer

In addition to the PSA test for detecting cancer, doctors also can perform a digital rectal exam, which may detect some cancers—but not all.

Because prostate cancers usually grow slowly, some researchers aren’t convinced that finding it early provides a significant advantage. On the other hand, some prostate cancers grow more quickly and can spread to other parts of the body. Unfortunately, neither the PSA test nor digital rectal exam can tell you whether the type of cancer you have is slow- or fast-growing.

For that, you will need a biopsy, a procedure done under ultrasound guidance that samples areas of the prostate gland, which are then studied under a microscope to determine whether cancer cells exist and if so, what type.

Another aspect in addressing prostate cancer is that the treatments can create side effects such as incontinence and problems having sex. The most common treatments include removal of the prostate or radiation. Some men may choose to just watch their cancer and follow a protocol for “active surveillance.”  

Because of the mixed opinions of the benefits of a PSA Test, instead of saying everyone should have the screening test, the American Urologic Association and American Cancer Society suggest that by the age of 50, men should start getting yearly PSA tests and rectal exams. If you have a family history or other risk factors, then screening can start as early as 40.  Regardless of age and background, I think every man should at the age of 40 start a conversation with their primary care doctor or urologists on the risks and benefits of the PSA Test.

New Technology – Prostate Cancer Screening

There are new blood and urine-based lab tests that can help enhance how we screen for prostate cancer. The most important new technology that has helped in screening for prostate cancer is imaging of the prostate with a 3 Tesla MRI. The MRI has the ability to show small suspicious areas within the prostate that can be targeted during the biopsy.

No test or imaging is perfect, and screening guidelines and technologies are always changing. So, when it comes to screening for prostate cancer, it’s best to have a good discussion with your doctor first on what can be done, what should be done and how to do it.