Prostate Cancer Screening: Should I Have a PSA Test?

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Prostate Cancer Screening: Should I Have a PSA Test?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Prostate Cancer Screening: Should I Have a PSA Test?

Get the facts

Your options

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

Key points to remember

  • Although many men who are older than 50 have this test as part of their regular checkups, experts agree that PSA tests are not right for all men. Talk with your doctor about your age, your health, and the pros and cons of PSA testing. He or she can help you decide.
  • A high level of PSA may mean cancer. But usually it isn't cancer. It's often something else, like an enlarged prostate or an infection.
  • A PSA test cannot show if you have cancer. You will need a prostate biopsy to find out if your high level of PSA is from cancer or something else.
  • A PSA test may help find cancer early, when it can be cured. But many PSA tests also find cancers that are slow-growing and may never cause a problem. Some cancers grow so quickly that even regular screening cannot find them early enough.
  • PSA tests aren't perfect. They may have abnormal results even when there isn't cancer (a false-positive result) or have normal results when a man has cancer (a false-negative result).
  • If you have a family history of prostate cancer, your risk of getting it may be higher than average. Even if you are at a higher risk, screening may not help you live longer.
FAQs

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. For most men, this slow growth means they have time to learn all they can before deciding whether to have treatment or which treatment to have.

Early prostate cancer usually doesn't cause symptoms. When prostate cancer is found 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.

What is a PSA test?

The prostate-specific antigen (PSA) test is a blood test. PSA is released into a man's blood by the cells of his 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. And it 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.

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. But a high PSA can also be linked to other causes that aren't cancer.

The amount of PSA in the blood normally increases as a man's prostate enlarges with age. But when you have prostate cancer, your PSA level increases even more over time.

The PSA test and digital rectal exam can suggest a problem when there is not one. This is called a false-positive result. Only about 20 to 30 out of 100 men who have a PSA test result greater than 4.0 ng/mL actually have prostate cancer, while 70 to 80 of them don't have prostate cancer.

These tests may also fail to detect a problem when there is one. This is called a false-negative result.

What does the PSA test NOT tell you?

A PSA test alone can't tell if you have prostate cancer. This test only shows the level of your PSA. And a PSA test can't tell why your level is high.

The prostate naturally gets bigger as a man gets older. More than half of all men who are older than 50 have an enlarged prostate. This affects the PSA level, making it less accurate as a way to detect cancer.

Because several other things can make a PSA level go up—for example, ejaculation or an infection in the prostate—your doctor may advise you to 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 make sure that you have prostate cancer. If the biopsy finds cancer, you must decide how or whether to treat it.

A few prostate cancers grow fast. Men who have fast-growing cancers are more likely to die from prostate cancer than men who have slower-growing cancers. But doctors can't tell which kinds of prostate cancer will grow quickly. So this means it's hard to know when treatment is needed. Treatments can have serious long-term side effects. They may cause health problems, including problems with your bladder, bowel, and erections. For this reason, some men choose not to have the PSA test.

In men who have not been diagnosed with prostate cancer, PSA velocity can show that there is a problem that needs further testing. PSA velocity is measured by looking at the rate of change in PSA levels over 2 or 3 years. PSA levels rise faster in men who have prostate cancer than they do in men who have enlarged prostates.

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 75 and who do not have serious health problems may gain the most from early detection and treatment.

What do the experts recommend?

Most medical experts say that men age 50 or older should talk to their doctors about 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 hard decisions and can lead to other health problems that are caused by the treatment for prostate cancer. Here's what some experts say:

  • The U.S. Preventive Services Task Force (USPSTF) says that most men should not be given PSA tests as part of routine medical checkups. Instead, each man should talk to his doctor to see if he should have the test.
    • The USPSTF says that men who are 75 or older should not be tested and that younger men should discuss the pros and cons of PSA testing before being tested.
    • The USPSTF also says that men younger than 75 with long-term medical problems and who expect to live less than 10 years are unlikely to benefit from testing.
  • 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.
  • The American Urological Association (AUA) recommends that men decide with their doctors about screening. If a man decides to be screened, the AUA says he should start at the age of 40 for a "baseline" score (a baseline score is a PSA level that can be used to compare with future test scores).

Why might your doctor recommend a PSA test?

Your doctor may recommend a PSA test if he or she thinks you may have prostate cancer.

Your doctor may discuss PSA screening if:

  • You are in your 50s or 60s and are in good health.
  • Your doctor wants to keep track of changes in your PSA level.
  • You are an African American or a Jamaican of African descent, which means that you have a greater chance of getting the kind of prostate cancer that grows and spreads.
  • Your father, brother, or son got prostate cancer before age 65.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have a PSA test Have a PSA test
  • It's a simple blood test. A needle is used to take a sample of blood from your arm.
  • A PSA test can help find prostate cancer early, while it is small and usually curable.
  • Testing could lead you to hard decisions about further testing and treatment.
  • Testing could lead to a diagnosis of cancer and treatments that can cause loss of bladder control and not being able to have an erection.
Don't have a PSA test Don't have a PSA test
  • You have regular checkups that don't include this test.
  • You avoid testing that could lead to a diagnosis of cancer and treatments that can cause other health problems, especially loss of bladder control and not being able to have an erection.
  • You may have treatable prostate cancer without knowing it.
  • Sometimes prostate cancer grows quickly. If this type of prostate cancer is not found early, it can shorten your life.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about having a prostate-specific antigen (PSA) test to screen for prostate cancer

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I have two children who are in high school right now, and both plan to go to college. It's important to me to provide for them and ensure that they have the money they need to finish their education. If I found out I had cancer, I would try any treatment that might offer me a chance to live longer, even if it has side effects. I'm going to have the PSA test.

Eric, age 56

For me, there is still too much uncertainty about the benefits of the PSA test. I tend to stay away from things that aren't yet proved, even when I know there is a chance that we might someday find out there is a benefit. I'm willing to take that chance. Because I want to avoid the risks of inexact test results and additional tests, I'm not going to have the test.

Mike, age 62

My health is great. I still run, play tennis, and travel a lot. At my age, you start to see friends getting sick and dying of one thing or another, and it makes you start to think about your own health more. I know that the PSA test isn't perfect, but I want to have every chance I can to treat cancer early if I have it.

Jacob, age 68

I've done some reading on this subject, and I know that I'm a lot more likely to die from my heart disease than from prostate cancer. Right now I'm focusing my efforts on controlling my blood pressure and cholesterol because I know that treating those things can help me live longer and better. I know that if I had the PSA test and it was high, I would just worry and be stressed out. That's not good for my heart either!

Pieter, age 67

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a PSA test

Reasons not to have a PSA test

Having prostate cancer and not treating it scares me more than the urinary and erection problems that cancer treatment may cause.

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

More important
Equally important
More important

I would do anything to fight prostate cancer, even if the side effects of treatment affect my quality of life.

I think the additional testing and treatment that might follow a positive test result would do me more harm than good.

More important
Equally important
More important

I want to know if I have prostate cancer.

I don't want to know if I have prostate cancer, because it may never affect my health.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having a PSA test

NOT having a PSA test

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Should all men over 50 have regular PSA tests?

  • YesNo, that's wrong. Although many men older than 50 have this test as part of their regular checkups, experts agree that the test isn't necessary for all men.
  • NoYou're right. Although many men older than 50 have this test as part of their regular checkups, experts agree that the test isn't necessary for all men.
  • I'm not sureIt may help to go back and read "Get the Facts." Although many men older than 50 have this test as part of their regular checkups, experts agree that the test isn't necessary for all men.
2.

Is it important to think about the side effects of prostate cancer treatment when making this decision?

  • YesIt's true. Prostate cancer treatment can cause loss of bladder control and not being able to have an erection. Having a PSA test could lead to a diagnosis of cancer and having to decide whether to have that treatment.
  • NoSorry, that's wrong. Prostate cancer treatment can cause loss of bladder control and not being able to have an erection. Having a PSA test could lead to a diagnosis of cancer and having to decide whether to have that treatment.
  • I'm not sureIt may help to go back and read "Compare your options." Prostate cancer treatment can cause loss of bladder control and not being able to have an erection. Having a PSA test could lead to a diagnosis of cancer and having to decide whether to have that treatment.
3.

Can a PSA test help find prostate cancer early, when it is usually curable?

  • YesYou're right. When prostate cancer is found early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate.
  • NoNo, that's wrong. When prostate cancer is found early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate.
  • I'm not sureIt may help to go back and read "Get the Facts." When prostate cancer is found early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits

Credits
Credits Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer J. Curtis Nickel, MD, FRCSC - Urology
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Prostate Cancer Screening: Should I Have a PSA Test?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your options

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

Key points to remember

  • Although many men who are older than 50 have this test as part of their regular checkups, experts agree that PSA tests are not right for all men. Talk with your doctor about your age, your health, and the pros and cons of PSA testing. He or she can help you decide.
  • A high level of PSA may mean cancer. But usually it isn't cancer. It's often something else, like an enlarged prostate or an infection.
  • A PSA test cannot show if you have cancer. You will need a prostate biopsy to find out if your high level of PSA is from cancer or something else.
  • A PSA test may help find cancer early, when it can be cured. But many PSA tests also find cancers that are slow-growing and may never cause a problem. Some cancers grow so quickly that even regular screening cannot find them early enough.
  • PSA tests aren't perfect. They may have abnormal results even when there isn't cancer (a false-positive result) or have normal results when a man has cancer (a false-negative result).
  • If you have a family history of prostate cancer, your risk of getting it may be higher than average. Even if you are at a higher risk, screening may not help you live longer.
FAQs

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. For most men, this slow growth means they have time to learn all they can before deciding whether to have treatment or which treatment to have.

Early prostate cancer usually doesn't cause symptoms. When prostate cancer is found 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.

What is a PSA test?

The prostate-specific antigen (PSA) test is a blood test. PSA is released into a man's blood by the cells of his 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. And it 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.

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. But a high PSA can also be linked to other causes that aren't cancer.

The amount of PSA in the blood normally increases as a man's prostate enlarges with age. But when you have prostate cancer, your PSA level increases even more over time.

The PSA test and digital rectal exam can suggest a problem when there is not one. This is called a false-positive result. Only about 20 to 30 out of 100 men who have a PSA test result greater than 4.0 ng/mL actually have prostate cancer, while 70 to 80 of them don't have prostate cancer.

These tests may also fail to detect a problem when there is one. This is called a false-negative result.

What does the PSA test NOT tell you?

A PSA test alone can't tell if you have prostate cancer. This test only shows the level of your PSA. And a PSA test can't tell why your level is high.

The prostate naturally gets bigger as a man gets older. More than half of all men who are older than 50 have an enlarged prostate. This affects the PSA level, making it less accurate as a way to detect cancer.

Because several other things can make a PSA level go up—for example, ejaculation or an infection in the prostate—your doctor may advise you to 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 make sure that you have prostate cancer. If the biopsy finds cancer, you must decide how or whether to treat it.

A few prostate cancers grow fast. Men who have fast-growing cancers are more likely to die from prostate cancer than men who have slower-growing cancers. But doctors can't tell which kinds of prostate cancer will grow quickly. So this means it's hard to know when treatment is needed. Treatments can have serious long-term side effects. They may cause health problems, including problems with your bladder, bowel, and erections. For this reason, some men choose not to have the PSA test.

In men who have not been diagnosed with prostate cancer, PSA velocity can show that there is a problem that needs further testing. PSA velocity is measured by looking at the rate of change in PSA levels over 2 or 3 years. PSA levels rise faster in men who have prostate cancer than they do in men who have enlarged prostates.

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 75 and who do not have serious health problems may gain the most from early detection and treatment.

What do the experts recommend?

Most medical experts say that men age 50 or older should talk to their doctors about 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 hard decisions and can lead to other health problems that are caused by the treatment for prostate cancer. Here's what some experts say:

  • The U.S. Preventive Services Task Force (USPSTF) says that most men should not be given PSA tests as part of routine medical checkups. Instead, each man should talk to his doctor to see if he should have the test.
    • The USPSTF says that men who are 75 or older should not be tested and that younger men should discuss the pros and cons of PSA testing before being tested.
    • The USPSTF also says that men younger than 75 with long-term medical problems and who expect to live less than 10 years are unlikely to benefit from testing.
  • 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.
  • The American Urological Association (AUA) recommends that men decide with their doctors about screening. If a man decides to be screened, the AUA says he should start at the age of 40 for a "baseline" score (a baseline score is a PSA level that can be used to compare with future test scores).

Why might your doctor recommend a PSA test?

Your doctor may recommend a PSA test if he or she thinks you may have prostate cancer.

Your doctor may discuss PSA screening if:

  • You are in your 50s or 60s and are in good health.
  • Your doctor wants to keep track of changes in your PSA level.
  • You are an African American or a Jamaican of African descent, which means that you have a greater chance of getting the kind of prostate cancer that grows and spreads.
  • Your father, brother, or son got prostate cancer before age 65.

2. Compare your options

  Have a PSA test Don't have a PSA test
What is usually involved?
  • It's a simple blood test. A needle is used to take a sample of blood from your arm.
  • You have regular checkups that don't include this test.
What are the benefits?
  • A PSA test can help find prostate cancer early, while it is small and usually curable.
  • You avoid testing that could lead to a diagnosis of cancer and treatments that can cause other health problems, especially loss of bladder control and not being able to have an erection.
What are the risks and side effects?
  • Testing could lead you to hard decisions about further testing and treatment.
  • Testing could lead to a diagnosis of cancer and treatments that can cause loss of bladder control and not being able to have an erection.
  • You may have treatable prostate cancer without knowing it.
  • Sometimes prostate cancer grows quickly. If this type of prostate cancer is not found early, it can shorten your life.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about having a prostate-specific antigen (PSA) test to screen for prostate cancer

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I have two children who are in high school right now, and both plan to go to college. It's important to me to provide for them and ensure that they have the money they need to finish their education. If I found out I had cancer, I would try any treatment that might offer me a chance to live longer, even if it has side effects. I'm going to have the PSA test."

— Eric, age 56

"For me, there is still too much uncertainty about the benefits of the PSA test. I tend to stay away from things that aren't yet proved, even when I know there is a chance that we might someday find out there is a benefit. I'm willing to take that chance. Because I want to avoid the risks of inexact test results and additional tests, I'm not going to have the test."

— Mike, age 62

"My health is great. I still run, play tennis, and travel a lot. At my age, you start to see friends getting sick and dying of one thing or another, and it makes you start to think about your own health more. I know that the PSA test isn't perfect, but I want to have every chance I can to treat cancer early if I have it."

— Jacob, age 68

"I've done some reading on this subject, and I know that I'm a lot more likely to die from my heart disease than from prostate cancer. Right now I'm focusing my efforts on controlling my blood pressure and cholesterol because I know that treating those things can help me live longer and better. I know that if I had the PSA test and it was high, I would just worry and be stressed out. That's not good for my heart either!"

— Pieter, age 67

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a PSA test

Reasons not to have a PSA test

Having prostate cancer and not treating it scares me more than the urinary and erection problems that cancer treatment may cause.

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

More important
Equally important
More important

I would do anything to fight prostate cancer, even if the side effects of treatment affect my quality of life.

I think the additional testing and treatment that might follow a positive test result would do me more harm than good.

More important
Equally important
More important

I want to know if I have prostate cancer.

I don't want to know if I have prostate cancer, because it may never affect my health.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having a PSA test

NOT having a PSA test

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Should all men over 50 have regular PSA tests?

  • Yes
  • No
  • I'm not sure
You're right. Although many men older than 50 have this test as part of their regular checkups, experts agree that the test isn't necessary for all men.

2. Is it important to think about the side effects of prostate cancer treatment when making this decision?

  • Yes
  • No
  • I'm not sure
It's true. Prostate cancer treatment can cause loss of bladder control and not being able to have an erection. Having a PSA test could lead to a diagnosis of cancer and having to decide whether to have that treatment.

3. Can a PSA test help find prostate cancer early, when it is usually curable?

  • Yes
  • No
  • I'm not sure
You're right. When prostate cancer is found early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer J. Curtis Nickel, MD, FRCSC - Urology

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