Who Should Have PSA Testing For Prostate Cancer?

July 26, 2018

Millions of men each year have their blood tested to determine their levels of prostate specific antigen (PSA), a normal protein. 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 over diagnosis and overtreatment.

In April 2017, the U.S. Preventive Services Task Force (USPTF) released preliminary new recommendations:

  • Screening isn’t recommended for men under 40 or for those 40 to 54 years old who are at average risk of prostate cancer.
  • Clinicians should inform men 55-69 about the benefits and harms of testing. Benefits including detecting the disease early and increasing the likelihood of cure. But there are potential harms of screening, including false-positive results that require additional testing, over diagnosis and overtreatment, and treatment complications such as incontinence and impotence.
  • For men older than 70, there is no strong evidence of benefit of screening.
  • African-American men, and men with a family history of the disease, should talk to their clinicians about their increased risk of prostate cancer and benefits and harms of screening.
Toni Choueiri, MD, director of the Lank Center for Genitourinary Oncology.

 

“These guidelines are correct in saying there is benefit to PSA screening, but it should be done selectively and following a discussion with your physician,” says Toni Choueiri, MD, director of the Lank Center for Genitourinary Oncology at Dana-Farber. “Often, we take into consideration the ‘physiologic’ age of the patient and his life expectancy – rather than age, per se.”

The American Cancer Society estimates that about 161,360 new cases of prostate cancer will be diagnosed in 2017, with 26,730 deaths. Mortality from the disease has been declining significantly for more than two decades. Choueiri believes the drop is partly due to PSA screening and early detection, and to better treatment of early but curable forms of the disease.