What's risky about a PSA test?

You may wonder how getting a test for prostate cancer could have a downside. After all, there's little risk involved in the test itself — it requires simply drawing blood for evaluation in a lab.

However, there are some potential dangers once the results are in. These include:

  • Worry about false-positive results caused by elevated PSA levels from something other than prostate cancer
  • Invasive, stressful, expensive or time-consuming follow-up tests
  • Stress or anxiety caused by knowing you have a slow-growing prostate cancer that doesn't need treatment
  • Deciding to have surgery, radiation or other treatments that cause side effects that you would not have if you did not undergo the treatment

Digital rectal examination


The PSA test isn't the only screening tool for prostate cancer. Digital rectal examination (DRE) is another important way to evaluate the prostate and look for signs of cancer.

Your doctor performs the test by inserting a gloved, lubricated finger into your rectum to feel the prostate for bumps or other abnormalities. It's a quick, safe and easy test.

In addition to checking for signs of prostate cancer, your doctor can use a DRE to check for signs of rectal cancer.

Think about your risk factors for prostate cancer

Knowing the risk factors for prostate cancer can help you determine if and when you want to begin prostate cancer screening. The main risk factors include:

  • Age. As you get older, your risk of prostate cancer increases. After age 50, your chance of having prostate cancer increases substantially. The majority of prostate cancers are found in men age 65 or older.

    The option to have PSA testing begins at age 40 and continues until you're at the age when your life expectancy is 10 years or fewer. Once you reach that age, the likelihood that a prostate cancer would progress and cause problems during the remainder of your lifetime is small.

  • Race. For reasons that aren't well understood, black men have a higher risk of developing and dying of prostate cancer.
  • Family history. If a close family member — your father or brother — was diagnosed with prostate cancer before age 65, your risk of the disease is greater than that of the average American man.

    If several of your first-degree relatives — father, brothers, sons — have had prostate cancer at an early age, your risk is considered very high.

  • Diet. A high-fat diet and obesity may increase your risk of prostate cancer.

Consider the varying viewpoints: What are the recommendations?

Organization Recommendation
American Urological Association (AUA) The AUA recommends that beginning at age 55, men engage in shared decision-making with their doctors about whether to undergo PSA screening. The AUA doesn’t recommend routine PSA screening for men over age 70, or for any man with less than a 10- to 15-year life expectancy.
American Cancer Society (ACS) The ACS recommends that men consult with their doctors to make a decision about PSA testing. According to the ACS, men should explore the risks and benefits of the PSA test starting at age 50 if they are at average risk of prostate cancer and have at least a 10-year life expectancy, at age 45 if they are at high risk and at age 40 if they are at very high risk (those with several first-degree relatives who had prostate cancer at an early age).
U.S. Preventive Services Task Force (USPSTF) The USPSTF recommends against PSA-based screening, regardless of age. The USPSTF states that there is moderate to high certainty that PSA testing has no net benefit or that harms outweigh benefits.
Mayo Clinic Mayo Clinic recommends offering PSA screening and DRE annually to men ages 50 to 70 with a life expectancy greater than 10 years. Men with risk factors for prostate cancer may need to begin screening earlier.

How does it add up?

A positive PSA test can be a lifesaver for some men, identifying prostate cancer that needs treatment early.

It's generally a good idea to have PSA testing done if you're at increased risk of prostate cancer. However, not all men need to have the screening. You may want to think twice if you're in a group of men unlikely to benefit from it.

After considering the pros and cons of screening, your age, general health and risk factors, your preferences and what the experts say, talk to your doctor. Together you can make the right decision for you.

Oct. 22, 2015 See more In-depth