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Should You Have the PSA Test?


You’ve probably heard a lot about the PSA test, the controversial tool used to screen for prostate cancer. There have been questions about its accuracy, its reliability, and whether it’s even necessary. Should you have it? And if so, what do you need to know beforehand? It’s a big decision. So, let’s go over some of the common questions and issues you can discuss with your doctor.
What is the PSA test? What does it measure?
The PSA test is a simple blood test used to screen for prostate cancer. It’s commonly used in conjunction with a digital rectal exam, or DRE. In a DRE, a doctor examines your prostate by inserting a gloved finger into your rectum.  
Generally speaking, men should consider having prostate cancer screenings around age 50, if they have no risk factors for the disease. At-risk men might start their screenings around age 40, or even earlier if there are special concerns. Risk factors for prostate cancer include family history, obesity, and getting older. African-American men are also at higher risk for prostate cancer, although scientists aren’t sure why.
PSA stands for prostate-specific antigen. It’s a protein that helps liquefy semen so that sperm can travel. Both cancerous cells and non-cancerous cells in the prostate make PSA. But cancer cells usually produce more PSA. So if your PSA levels are higher than normal, that can be a cause for concern.
PSA is measured in nanograms per milliliters (ng/ml). The cutoff point is 4.0 ng/ml, meaning that any reading that falls below 4.0 ng/ml is considered normal and anything higher than 4.0 ng/ml is considered abnormal. However, there are many factors that can raise and lower PSA, not just cancer.
Why is a simple blood test so controversial?
There are several reasons.
  • High PSA levels do not always mean you have cancer. According to the Mayo Clinic, only 25% of men who with abnormal PSA tests actually have cancer. A number of conditions can increase PSA levels. Prostate infection (prostatitis) can raise PSA substantially. Benign prostate enlargement (also called benign prostatic hyperplasia or BPH) and inflammation can also make it rise. As you get older, your prostate makes more PSA. And even recent ejaculation can make PSA levels rise a little bit.
  • On the other hand, you can have normal PSA levels and still have cancer. Sometimes cancerous cells just don’t make that much PSA, especially if they are growing quickly. And some BPH medications lower PSA levels. So it’s quite possible to have a normal PSA test and still have cancer. In fact, approximately 20% of men with normal results do have cancer, according to Harvard Health Commentaries.
  • If you do have prostate cancer, it may not need to be treated. Not treating cancer might sound absurd. But in some cases, the treatment is more serious than the cancer itself. Surgery and radiation can be harmful.  Also, prostate cancer treatment can have a number of side effects, including incontinence, erectile dysfunction (ED), and problems with bowel function. 
Some doctors recommend “watchful waiting” when a patient has prostate cancer. This means that there’s no direct treatment, but the patient is closely monitored so that if the situation changes, treatment can begin. Often, this means that the patient has more frequent PSA tests over a course of time.
If the PSA test has so many flaws, why is it still performed?
The PSA test can still detect 80% of prostate cancers. It’s also good for catching cancer early. And the earlier the better – cancer that’s discovered early is more likely to be cured. Doctors also use the PSA test to diagnose other prostate conditions, like BPH. 
What if my PSA test comes back positive?
Don’t panic! It doesn’t mean you have cancer. Your doctor will probably recommend other tests to rule out other problems. You might also have a biopsy, in which the doctor takes tissue from your prostate and analyzes those cells to see if they’re cancerous. But just take it one step at a time. Be open with your doctor about any questions, concerns, or anxieties you and your family may have.
So, should I have a PSA test?
Maybe. There is no right or wrong answer to this question. Having a PSA test is a very personal decision and your doctor can help you choose what’s best for you. 
If you do decide to have a PSA test, approach it with an open mind. Remember that high or low results could mean many different things. Nothing is definite without further testing and review.