Prostate Cancer Screening: Should I Get a PSA Test?
Regularly showing up to your doctor’s office for health screenings seems like a no-brainer. But lately, one screening in particular has been raising a lot of questions: the prostate specific antigen (PSA) blood test.
"There is no test that is perfect and the PSA test falls into that category of ‘not perfect,’" explains Scott Massa MD, an internal medicine doctor at Physician Associates of Good Sam – Delhi.
What is a PSA Test?
PSA is a protein produced by prostate cells. During this exam your doctor takes a blood sample to test for elevated levels of PSA. A high PSA has been linked to an increased chance of having prostate cancer; however, PSA test results cannot diagnose prostate cancer. Only a prostate biopsy can diagnose this cancer.
What’s the Controversy?
Screening for prostate cancer involves another part, too, which is the digital rectal exam. “The one thing that nobody is against is the physical exam part. There’s absolutely no harm and no cost to that,” Dr. Massa says. “Where the controversy comes in is the [PSA] blood test.”
While the PSA test can help identify a number of men who have cancer, the real issue is that the test cannot determine whether the cancer is aggressive or non-aggressive. In some prostate cancer cases, the cancer grows so slowly that it never becomes a true threat to an individual's health or life, meaning they don’t necessarily need radiation or chemotherapy, or surgical treatment.
Furthermore, a PSA screening can reveal a false positive, causing unnecessary worry. The most common cause of a false positive reading is the prostate gland getting bigger, which happens universally as men age. For this reason, “between [ages] 70 and 80 you’ll get some disagreement as to whether the test is worthwhile or not.”
On the other hand, there are other forms of prostate cancer that can be rapidly growing and deadly. "They don’t have a good way of analyzing the cancer to know which is which,” Dr. Massa explains.
The Bottom Line: What Does Dr. Massa Recommend?
If something suspicious is found during the digital rectal exam, Dr. Massa recommends getting a PSA test.
Similarly, "if I had a patient between the ages of 50 and 70 and he said ‘I want a PSA,’ I would explain the risks and benefits of doing that, but after I explained it, if he still wants it, I’d go ahead and order it,” Dr. Massa explains.