Men have been increasingly confused about whether to get a PSA (prostate-specific antigen) test for prostate cancer screening, as various medical organizations and professionals have changed their minds and recommendations about it over the years. The US Preventive Services Task Force (USPTF) has issued new guidelines, stating that the test may provide a “small advantage for some men.” It also notes that doctors should “offer or provide this service for selected patients depending on individual circumstances.” Men older than 70, according to the task force, do not need to be screened with PSA.
The new guidelines recommend that doctors talk with selected patients aged 55 to 69 and make a prostate cancer screening decision based on their individual and unique needs. This means that your doctor shouldn’t discuss prostate cancer screening with you until you’re 55 unless you are in a “high-risk group.” However, up to three-quarters of men who get the test done receive a false positive result, which can then lead to unnecessary anxiety, a prostate biopsy, and the risk of side effects from the biopsy.
Moreover, there are more than a dozen reasons why a PSA level may be elevated, and many have nothing to do with the prostate at all, or specifically prostate cancer. Therefore, if you have one elevated PSA value, you should probably wait a few weeks and have another test done to see if the results are the same, instead of basing immediate action on a single test. Meanwhile, you should also consider all the other factors that can elevate PSA and determine if any of them fit your situation, and if you can do anything to influence a lower PSA value on the next test. For example, don’t ride a bike the morning of the test or have sex, or do other things that may impact the test result.
The PSA test as part of prostate cancer screening is not foolproof, as it undoubtedly has problems. However, the problem with the test is not the test itself but what happens after the test. This is where the USPTF recommendation fails. Too often, doctors “rush to biopsy” for both insurance and liability reasons, rather than adopting a short term “wait and see” approach to determine if the test result is just an aberration. The USPTF seems to be mostly concerned about this rather than proposing a recommendation and process that genuinely helps the patient and actually relieves any anxiety about whether you have a more serious disorder.
Two underlying factors seem to guide the USPTF. First, the unnecessary stress that the PSA test sometimes causes, and second, the rush to aggressively treat something that may be benign, slow-growing, and cause no immediate harm compared to the side effects of more aggressive treatment. Two valid points.
The solution is not to publicly undermine the PSA and its screening benefits, like the USPTF is doing with this new recommendation. The detection process still starts with the PSA test, and for many reasons, it will continue like this for some time. So publicly undermining the importance of the test in the media, like the USPTF is doing, is irresponsible and gives men more of a reason to avoid the dreaded “digital rectal examination” and ignore the need for a PSA test at all.
Remember, prostate cancer is a serious disease, and the decisions you take about your treatment and screening options will determine your life and lifestyle going forward. Don’t avoid the PSA test. More and more men are getting prostate cancer in their 30s, and it’s not just an “old man’s disease.” Taking responsibility for your health starts with knowing your test results.
Treat the PSA test like you would a blood pressure or cholesterol test. Knowing something is not normal gives you the power to take action for better health in the long term.
