Is prostate cancer PSA screening right for you?
9/30/2019 by Dr. John Matulis
In some men, prostate cancer can be very dangerous. However, most prostate cancers are slow-growing and not destined to cause any problems. The majority of men with prostate cancer are said to die with it and not because of it. Unfortunately, determining whether a man has a "benign" or a dangerous cancer is really difficult. Until one of the bad cancers is quite advanced, there usually are no symptoms to indicate that a man has the dangerous type.
By screening men for prostate cancer, we hope to catch the small number of these bad cancers, which if untreated, can shorten his life. The U.S. Preventive Services Task Force (USPSTF) makes recommendations about screening, and they change as we learn more about prostate cancer.
The USPSTF doesn't recommend prostate cancer screening for men age 70 or older. If you're age 55 to 29 years, the decision to undergo prostate-specific antigen (PSA)-based screening for prostate cancer is up to you and your health care provider.
There is no right answer on this. When making this decision, be sure to discuss the potential benefits and harms with your health care provider. And many men do experience harms from the screening, including:
- False-positive results that require additional testing and possible prostate biopsy
- Over-diagnosis, such as finding a prostate cancer that would never cause you harm
- Treatment complications, such as incontinence and erectile dysfunction
You should also take into consideration your own values and preferences, as well as any risks for prostate cancer based on family history, race/ethnicity or other medical conditions.
If you do decide to be screened and the PSA is elevated, you'll probably have a biopsy. While a biopsy sometimes provides an answer, sometimes it doesn't. This cycle of testing, often without clear answers, can cause a lot of frustration and anxiety. Plus, the tests may cause complications or discomfort.
These uncertainties make the decision to get a simple PSA blood test a complicated one. There isn't one answer that is right for everyone; you should take the time to learn all you can about the risks and benefits. And together with your provider, come to a decision with which you're comfortable.
Dr. John Matulis is a consultant in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM). In addition to general internal medicine, he's board certified in preventive medicine and has an interest in quality improvement.