Who should have PSA testing for prostate cancer?


Millions of men each year have their blood tested for prostate specific antigen, or PSA, a normal protein whose levels may be elevated in men with prostate cancer or other benign diseases of the prostate.

However, experts have disagreed on who should be tested, when and how frequently. Some are concerned about whether the benefits outweigh the risks of overdiagnosis and overtreatment. In fact, a federal advisory task force in 2012 recommended against routine PSA testing for healthy men – though many physicians disagreed.

Philip Kantoff, MD, Director of the Lank Center for Genitourinary Oncology

Philip Kantoff, MD, director of the Lank Center for Genitourinary Oncology

Now, the American Urological Association (AUA) has released new guidelines, based on the findings of clinical studies, that specify groups of men who may benefit from testing.

  • Screening isn’t recommended for men under 40 or for those 40 to 54 years old who are at average risk of prostate cancer.
  • Men from 55 to 69 years old should discuss with their physician about the benefits and harms of testing. Benefits: Prostate cancer might be detected and treated at an early stage and increase your likelihood of cure and not dying of prostate cancer – though doctors can’t predict whether the cancer will ever become dangerous. The downside: A suspicious PSA reading usually leads to an invasive biopsy, which in turn could lead to unnecessary treatment and the risk of side effects such as impotence and incontinence.
  • For men beyond age 70, there is no evidence of benefit of screening.
  • Men younger than 55 who are at higher risk – because they are African- American or have a family history of prostate cancer should talk with their physician to make a decision.
  • For men who do decide to have PSA testing, it need not be done more often than every two years.

“These guidelines are in effect saying there is benefit to PSA screening but it should be done selectively,” says Philip Kantoff, MD, director of the Lank Center for Genitourinary Oncology at Dana-Farber, as well as the Chair of the Executive Committee for Clinical Research. He served on an independent panel of experts that weighed the evidence and formulated the guidelines.

Kantoff says that the potential benefits of screening are greatest in the 55-to-69 age group because the prevalence of prostate cancer is highest then.

The American Cancer Society estimates that 238,590 cases of prostate cancer will be diagnosed in 2013, with 29,720 deaths. Mortality from the disease has been declining significantly for more than two decades. Kantoff believes the drop is partly due to PSA screening and early detection, and to better treatment of early but curable disease.

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