Prostate health is a concern (and certainly should be) for most men over the age of 40 and particularly those over the age of 50. The standard test used to diagnose prostate cancer is the prostate-specific-antigen (PSA). However, new research is showing that the PSA test may have some serious flaws.
Prostate Cancer
Prostate cancer is the third most common cause of death from cancer in men of all ages, and is the most common cause of death from cancer in men over the age of 75. Prostate cancer is rarely found in men younger than 40.
To date, the prostate-specific antigen (PSA blood test has often been done to screen men for prostate cancer. However recent research has created uncertainty as to whether the benefits of screening (via a PSA test) ultimately outweigh the risk of over diagnosis. In a review by the U.S. Preventative Services Task Force, researchers found that:
- PSA-based screening does not significantly reduce prostate cancer-specific or all-cause mortality
- After three or four screening rounds, 12-13% of screened men had false-positive results
- False-positive PSA test results are associated with adverse psychological effects, but the U.S. Preventative Services Task Force could not estimate their magnitude
- Serious infections or urine retention occurred after 0.5-1.0% of prostate biopsies performed after a positive PSA test
The researchers concluded that PSA screening results offer little or no reduction in prostate cancer-specific mortality, and are associated with problems related to subsequent evaluation and treatments, some of which may be unnecessary.
This is not to say that there is absolutely no value in PSA screening, but according to the National Cancer Institute, “A man’s PSA level alone does not give doctors enough information to distinguish between benign prostate conditions (such as prostatitis and benign prostate hyperplasia (BPH)) and cancer. However, the U.S. Food and Drug Administration (FDA) has approved the use of the PSA test, along with a digital rectal exam, to help detect prostate cancer in men 50 years of age or older.”
Bottom Line
Many things other than prostate cancer can cause an elevation of PSA, including swelling of the prostate gland, infection, and recent ejaculation, as well as benign prostatic hyperplasia, or enlarged prostate, which is one of the most common conditions that affect men as they age, also can raise PSA. If your PSA is elevated, you should ask your doctor to first test for and address these other possible issues, and then test your PSA again to see if the levels go down. The research suggests that only after you have ruled out these other issues should you consider following through with a prostate biopsy and/or other more invasive testing for prostate cancer.
References
- Gomella LG, et al. Can J Urol. 2011 Oct; 18(5):5875-83.
- Chou R, et al. Ann Intern Med. 2011 Dec 6; 155(11):762-71.
- Prostate-Specific Antigen (PSA Test. National Cancer Institute. http://www.cancer.gov/cancertopics/factsheet/detection/PSA.
