By Craig Gillard, MD
Chief of Surgery & Urologist
Jordan Hospital

Over the last few years there have been some concerns raised about the validity and reliability of the prostate specific antigen (PSA) test as a screening tool for prostate cancer.  The American Urological Association (AUA) has heard these concerns and conducted an extensive review of the literature to develop guidelines to aid the healthcare community in navigating the path for each individual patient.

 The PSA test is not perfect.  However, when used correctly, the blood test can give important information in diagnosing, assessing the risk of developing, and monitoring prostate disease including cancer.  It is a tool that facilitates informed decision making for patients and their healthcare providers.  PSA testing should not be used on its own but as part of a multivariable approach to early prostate cancer detection.

Prostate cancer is the second most common cancer in men and the second leading cause of death in men with 1 in 6 men diagnosed with prostate cancer in their lifetime.  African American men and men with a family history of prostate cancer have a higher risk of developing the disease.

Because prostate cancer often grows slowly and may not cause health problems, prostate cancer is different than other cancers.  In 2012 more than 240,000 men were diagnosed with the disease but only 28,000 died.  Many men with prostate cancer will never know they have it unless they get treated.  Often the statement is made that more men die with prostate cancer than from it, and if you live long enough you will get it.

We need to be more specific in the decision process for screening for prostate cancer.  Men should speak with their healthcare provider about the psychological and physical benefits and risks to screening in addition to factors that increase their risk for prostate cancer including a family history of prostate cancer and being African American.  Men should also be aware of factors that can affect PSA levels including but not limited to:

• Age
• Size of the prostate
• Infection in the prostate gland
• Activity/exercise
• Job environment
• Injury

Ultimately, men and their healthcare providers should weigh the benefits and the risks to screening for prostate cancer.  Each man is an individual and processes information differently and uniquely.  The decision-making process must be individualized and personalized for each man to appropriately make the decision that is right for him.

Risks and Benefits of PSA Tests

Benefits

• A normal PSA test may put your mind at ease.
• Detect prostate cancer early before it spreads.
• Early treatment of prostate cancer may help some men avoid problems from cancer.
• Help some men live longer.

Risks

• A normal test may miss some prostate cancers (false negative results)
• An elevated PSA does not necessarily mean prostate cancer (false positive results)
• May lead to an unneeded trans-ultrasound prostate biopsy
• Diagnosis of a prostate cancer that potentially would not have caused a problem
• Side effects of treating prostate cancer

If you have prostate cancer concerns, consult with your primary care doctor or scheduled a consulation with Dr. Gillard by calling at (508) 732-6770.