Prostate cancer screening: Should you get a PSA test?

Cancer screening tests — including the prostate-specific antigen (PSA) test to look for signs of prostate cancer — can be a good idea. Prostate cancer screening can help identify cancer early on, when treatment is most effective.

But it isn't perfect. Some men may find that the downsides of prostate cancer screening outweigh the potential benefits.

Ultimately, whether to have prostate cancer screening is something you should decide after discussing it with your doctor, considering your risk factors and weighing your personal preferences.

Here's information to help you prepare for a conversation with your doctor.

What is PSA?

Prostate-specific antigen (PSA) is a protein produced by both cancerous (malignant) and noncancerous (benign) prostate tissue. A small amount of PSA normally enters the bloodstream.

Prostate cancer cells usually make more PSA than do benign cells, causing PSA levels in your blood to rise.

Besides the PSA number itself, your doctor will consider a number of other factors to evaluate your PSA scores:

• Your age
• The size of your prostate gland
• How quickly your PSA levels are changing
• Whether you're taking medications that affect PSA measurements, such as finasteride (Propecia, Proscar) and dutasteride (Avodart)

PSA testing is sometimes combined with a digital rectal exam (DRE) to feel the prostate for abnormalities.

What increases the risk of prostate cancer?

Knowing the risk factors for prostate cancer can help you determine if and when you want to begin prostate cancer screening. The main risk factors include:

• Age. As you get older, your risk of prostate cancer increases. After age 50, your chance of having prostate cancer is increased.
• Race. For reasons that aren't well-understood, black men have a higher risk of developing and dying of prostate cancer.
• Family history. If a close family member — your father, uncle or brother — was diagnosed with prostate cancer before age 65, your risk of the disease is greater than average.
• Inherited gene mutations. Gene mutations associated with prostate cancer risk include BRCA1 and BRCA2. These genes are most closely associated with breast cancer, but they increase the risk of other types of cancer, too. Your doctor might recommend considering genetic testing if you have a strong family history of cancer or if a blood relative has been diagnosed with a gene mutation.
• Diet. A diet that's high in animal fats and low in vegetables may increase your risk of prostate cancer.

What are the pros and cons of prostate cancer screening?

There are a number of pros and cons to the PSA test.

What's the advantage of a PSA test?

Detecting certain types of prostate cancer early can be critical. Elevated PSA results may reveal prostate cancer that's likely to spread to other parts of your body (metastasize), or they may reveal a quick-growing cancer that's likely to cause other problems.

Early treatment can help catch the cancer before it becomes life-threatening or causes serious symptoms. In some cases, identifying cancer early means you will need less aggressive treatment — thus reducing your risk of certain side effects, such as erectile dysfunction and incontinence.

What's risky about a PSA test?

You may wonder how getting a test for prostate cancer could have a downside. After all, there's little risk involved in the test itself — it requires simply drawing blood for evaluation in a lab.

However, there are some potential downsides once the results are in. These include:

• Elevated PSA levels can have other causes, such as benign prostate enlargement (benign prostatic hyperplasia) or prostate infection (prostatitis). These false-positives are common.
• Some prostate cancers may not produce much PSA. It's possible to have what's known as a "false-negative" — a test result that incorrectly indicates you don't have prostate cancer when you do.
• Follow-up tests to check out the cause of an elevated PSA test can be invasive, stressful, expensive or time-consuming.
• Living with a slow-growing prostate cancer that doesn't need treatment might cause stress and anxiety.

What do experts recommend?

Most medical organizations encourage men in their 50s to discuss the pros and cons of prostate cancer screening with their doctors. The discussion should include a review of your risk factors and your preferences about screening.

You might consider starting the discussions sooner if you're black, have a family history of prostate cancer or have other risk factors.

If you choose to have prostate cancer screening, most organizations recommend stopping around age 70 or if you develop other serious medical conditions that limit your life expectancy.