Top ten things you should know about PSA testing for prostate cancer

The current controversy over PSA testing is actually not about whether we should detect prostate cancer, but whether all men who receive treatment actually need treatment. Because prostate cancer is slow growing not all men need treatment; some men can simply have their cancers monitored to see if the cancer grows (called active surveillance).

We advocate for patients who choose to monitor their cancers while also being strong in our advice to patients who may be reluctant to treat their cancer when we feel that a man should have treatment.

It is important to have a thorough discussion of the risks and benefits of prostate cancer screening with your primary care physician and urologist so that you can make a decision that is right for you.

Our hope is that this article will help you understand the issue and make informed decisions about your health care.

1. What is a PSA test? A PSA test is a blood test that is used to detect prostate cancer. PSA stands for Prostate Specific Antigen, a protein made in the prostate that leaks into the blood stream and can be detected. An elevated PSA may indicate you have prostate cancer.

Prostate cancer is detected in men with a combination of two tests – a manual exam of the prostate (digital rectal exam or DRE) and the PSA blood test. PSA testing has been clearly shown to help detect and treat prostate cancer early, before it spreads. A man who is screened for prostate cancer has less chance of developing incurable prostate cancer and is less likely to die from prostate cancer.

2. What is a normal PSA? There is no such thing as “normal” when it comes to PSA. Cancer is rarely found in men with PSA values less than 1. The higher the PSA, the higher the chance that a person has cancer. It is also very important to follow the trend in the PSA value (is it climbing? how fast?).

3. Does an Abnormal PSA test mean I have prostate cancer? No. In fact most high PSA tests do not mean a man has prostate cancer. Many men with elevated numbers never do get cancer even though they are at higher risk.

4. When should I get a PSA test? We recommend that a baseline serum PSA level be obtained in men in their 40s who have made an informed decision to pursue early detection of prostate cancer.

5. How often should I get a PSA? We recommend yearly testing for men age 50 and over who have at least a 10 year life expectancy. Men who have elevated PSA levels are followed more frequently.

6. If my PSA is normal, do I still need a prostate exam? Yes. We find many prostate cancers by physical exam that do not raise the PSA level. The cancer will make the prostate feel larger or firm in the area where the cancer is.

7. What PSA is too high? At Metro Urology we believe that a PSA should be 2.5 or less for men under 60, and less than 4.0 for men over 60. But the trend of the PSA value is also important. A rapidly rising PSA could be concerning, even if the number is still less than 2.5 or 4.0.

8. What happens if my PSA is too high? A PSA test that is too high requires a discussion with one of our physicians at Metro Urology to discuss your individual risk of prostate cancer. We can help you make the decision regarding further evaluation. Most men will be advised to have a prostate biopsy to determine if their prostate contains cancer.

9. What if my PSA is high but my prostate feels “normal”? This is very common. Most cancers are found early using the PSA test, before they grow out of the prostate and spread (called metastasis). Your physician may still recommend a biopsy because, if cancer is found, it is usually very treatable.

10. I have heard PSA testing is not accurate. Do all doctors agree on PSA testing? Recently, several prominent medical organizations have changed their recommendations regarding whether or not men should undergo prostate cancer screening. These conflicting reports lead to significant patient confusion.

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