5 facts about prostate specific antigen (PSA) tests

According to the American Cancer Society, 1 in 8 men will be diagnosed with prostate cancer during his lifetime, and prostate cancer is the second leading cause of cancer death in American men. Here are five things you should know about prostate cancer and prostate specific antigen (PSA) tests.

1. Prostate cancer is silent for many men.

In most men, prostate cancer displays few early symptoms. Urinary symptoms, such as decreased force of urinary stream or nocturia (waking during the night because you need to urinate), are common in aging men; but, in general, these are not associated with prostate cancer. Symptoms such as bone pain, blood in urine or weight loss can be found if prostate cancer has spread.

2. Some men are at a greater risk for developing prostate cancer.

All men can develop prostate cancer. However, there are some risk factors that increase your likelihood. Older men are at increased risk. African American men and men with one or more close relatives who have had prostate cancer also are at increased risk. Your risk also will be higher if you have a close relative diagnosed with prostate cancer prior to age 55.

3. PSA tests do not diagnose prostate cancer.

A PSA test is a blood test used primarily to screen for elevated levels of the prostate specific antigen (PSA) released by the prostate. It can be elevated for a variety of reasons. PSA screening continues to be a highly debated, controversial topic among the medical community. It is important to note that PSA is not capable of diagnosing prostate cancer, but it is a screening test to help predict the risk of prostate cancer.

There is no universally accepted threshold value above which total PSA is considered abnormal, as PSA values change depending on your age and race.

4. There are some downsides with a PSA test.

The actual PSA test has few side effects or risks. It requires a simple blood draw for evaluation in a lab. However, there are some potential downsides once the results are in. These could 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. This is a test result that incorrectly indicates you don't have prostate cancer when you actually 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.

5. There are established screening guidelines for men of average risk of prostate cancer.

The American Urological Association has established guidelines for PSA tests to help health care providers and patients determine the best screening schedule. These guidelines are for men of average risk, and the goal is to reduce mortality associated with prostate cancer. The guidelines are:

1. Under age 40: Recommend against any PSA test because PSA levels can be elevated for other common reasons and leads to false positive test results.
2. Ages 40–54: No routine screening in men with average risk. However, men at higher risk may benefit from a PSA test. This could include African American men and those with a strong family history of prostate cancer.
3. Ages 55–69: The greatest benefit of screening appears to be in this age group. To reduce any potential harms of screening, a test interval of every two years or more may be preferred over annual testing. The decision to undergo PSA tests involves weighing the benefits against the potential harms associated with screening and treatment.
4. Ages 70+: Not recommended.

Talk with your health care provider about the benefits, risks and limitations of a PSA test to determine the best screening option for you and your situation.

Melissa Nissen, M.D., is an urologist in Eau Claire, Wisconsin.