For men over a certain age, the decision of whether to get a PSA (prostate-specific antigen) test to screen for prostate cancer looms large. On one hand, the simple blood test can potentially catch aggressive prostate cancer early, when it’s most treatable. On the flip side, PSA testing can also lead to over-diagnosis, unnecessary biopsies, and treatment side effects that impact quality of life for a cancer that may have been slow-growing and never spread.
So what’s a man to do? The answer, according to experts, is to have an informed discussion with your doctor about your individual risk factors and preferences. It’s not a one-size-fits-all decision, but rather one that each man should make in partnership with his healthcare provider.
Understanding the Pros of PSA Testing
First, let’s look at the potential benefits of getting screened:
- Early detection of aggressive cancer. When prostate cancer is caught early before it spreads, the 5-year survival rate is nearly 100%. PSA testing can help identify fast-growing, high-risk prostate cancer at a stage when it’s very treatable.
- Establishes a baseline PSA level. Getting a baseline PSA in your 40s allows you and your doctor to track any concerning increases over time, since the rate of change may be more telling than the absolute level.
- Provides peace of mind. For some men, especially those with risk factors like family history, a normal PSA result offers reassurance and a sigh of relief.
The Case for Caution: Cons of PSA Tests
However, the PSA test is not perfect. Some of the drawbacks include:
- High risk of false positives. Elevated PSA levels don’t always mean cancer. Prostate inflammation, recent ejaculation, and even bike riding can cause a spike, often leading to unnecessary anxiety and invasive biopsies to investigate.
- Inability to differentiate aggressive vs indolent cancer. Most prostate cancers detected by screening are slow-growing and unlikely to ever cause symptoms or shorten lifespan. But the PSA can’t distinguish these from the minority of aggressive cases.
- Potential for over-treatment and side effects. A high PSA often leads to treatment with surgery or radiation for a cancer that may never have needed treating. These come with risks of incontinence, erectile dysfunction, and other side effects.
Possible harms of prostate cancer screening with the PSA test include false-positive results and over-treatment – treatment of a prostate cancer that would never have caused symptoms.
– Canadian Cancer Society
Shared Decision-Making Is Key
Ultimately, whether the pros outweigh the cons for you depends on factors like:
- Your age and life expectancy
- Family history of prostate cancer
- Your philosophy on screening tests
- Your feelings about potential side effects of treatment
It’s a very personal choice that you should make after a frank discussion with your doctor about your values and preferences. Organizations like the American Cancer Society and U.S. Preventive Services Task Force recommend this shared decision-making process start at age 50 for men at average risk and earlier for those at higher risk.
The decision about whether to be screened for prostate cancer should be an individual one. Screening should only be done after a detailed discussion with your health care provider about the potential benefits and harms.
– American Cancer Society
If you do opt for PSA testing, be sure you understand what the results could mean and what next steps may be needed, such as additional PSA tests, imaging, or biopsies. Have a plan in place with your doctor for how you’ll react to different scenarios.
The Bottom Line on PSA Screening
There’s no easy universal answer on whether all men should get their PSA levels checked routinely. Like many cancer screening decisions, it requires carefully weighing personal risk factors against the limitations of the test and potential complications of follow-up. The most important thing is being proactive, informed, and working closely with your healthcare team to arrive at a plan you’re comfortable with based on your unique situation. With the right approach, PSA testing can be a valuable tool in detecting prostate cancer early in those who will benefit most, while avoiding unnecessary procedures for those who may not need them.
