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
  • False reassurance from a PSA test that doesn't reveal cancer (false-negative), leading to a missed diagnosis of aggressive prostate cancer that needs treatment
  • 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 are more harmful than untreated cancer

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. A DRE should always be done with a PSA test when screening for prostate cancer. This will help minimize the risk of missing prostate cancer — or wrongly identifying a benign prostate abnormality as 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, 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).
Centers for Disease Control and Prevention (CDC) The CDC recommends against PSA-based screening for men who do not have symptoms, but supports discussions between men and their doctors to make informed decisions about screening based on individual risks and preferences.
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.
American College of Preventive Medicine (ACPM) The ACPM recommends that a man decide about whether to have PSA testing after discussing the risks and benefits with his doctor. The ACPM considers the need for screening questionable in older men with other chronic illnesses and men with life expectancies of fewer than 10 years.
Institute for Clinical Systems Improvement (ICSI) The ICSI states that, while there is good evidence that PSA screening can detect early-stage prostate cancer, there is mixed or inconclusive evidence to clearly determine whether early detection improves health outcomes. It recommends that a man decide what's right for him based on talking with his doctor.
Mayo Clinic Mayo Clinic recommends offering PSA screening and DRE annually to men ages 50 to 75 with a life expectancy greater than 10 years, to African-American men ages 45 to 75 with a life expectancy greater than 10 years, and to men ages 45 to 75 years with a positive family history of prostate cancer and a life expectancy greater than 10 years.

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.

May 07, 2013 See more In-depth