Should You Take the PSA Test?

Historically known as the “gold-standard” in prostate cancer testing, the prostate-specific antigen (PSA) test is commonly used to diagnose and monitor prostate cancer progression. The PSA is a protein enzyme produced by the prostate, which facilitates sperm transport. You may be recommended the PSA test if you have a higher risk for prostate cancer, or have been experiencing recurring issues with urination, erectile dysfunction, or ejaculation.

An elevated PSA level may then suggest a need for further investigation by imaging and/or biopsy of the prostate. This will allow your doctor to check for abnormal growths and confirm if a prostate cancer diagnosis is appropriate.

Unfortunately, while highly effective at detecting possible cases of prostate cancer, the PSA test can be an oversensitive alarm at times. It turns out that many patients with prostate cancer detected through the PSA test may not actually need any medical treatment due to the indolent nature of the disease.

This means that many patients with PSA-detected prostate cancer may be overtreated with surgery or radiotherapy, despite the fact that their cancer would likely not cause any problems in their lifetime. It would be more likely for some to eventually die of other causes.

As prostate cancer is generally slow-growing, detecting a few small tumors may unnecessarily encourage further intervention (e.g. treatment or biopsy). While they may never actually grow to become life-threatening, the interventions conducted can put you at risk of temporary or permanent issues with urinary, bowel and sexual functions. You can rest assured however, that your doctor will discuss these risks with you, before deciding if you should take the next step.

At the end of the day, the PSA test still remains an important net that catches the worst cases of prostate cancer. While not every age will need the test, at a certain risk level, regular testing will help doctors to intervene before the onset of advanced prostate cancer. Your doctor will help guide you to make an informed decision on whether this test is the right choice for you according to your needs and preferences.

According to prostate cancer screening guidelines from the American Cancer Society, men aged 50 and above should take the test, while the American Urological Association suggests regular screening every two to four years for those aged between 50 to 69.

However, if you have a higher risk based on your genetics or family history, you may be offered the test earlier, at age 40 to 45. Notably, Black people face a higher risk of fatal prostate cancer three to nine years earlier than the general population, and should consider earlier prostate cancer screening.

On the other hand, if you have no symptoms and have a life expectancy of less than 10 years, whether due to age or other health issues, likely, you will not need to worry about prostate cancer due to its slow nature. Those above 70 are also recommended against screening, according to the US Preventive Services Task Force.

Ultimately, your doctor will be able to customize your screening intervals according to your preferences, age, risk of prostate cancer and overall health.

Before making your decision, you should be ready to consider the following questions:

• Are you keen on being treated while knowing that you may not need it? For example, the test may detect slow-growing tumors that may never threaten your health.
• Do you value finding the cancer early more than the potential risks of screening and treatment?

As each person’s life is different, the right answer for you will likely differ from others. If you are confident of your decision, do let your doctor know about your preferences. However, if the questions raise some anxiety and uneasiness, your doctor can help provide their perspective on your specific case.

Learn more: The PSA Test: What to Expect