The PSA test
The introduction of Prostate Specific Antigen (PSA) testing in 1987 has led to a rapid rise in the reported incidence of prostate cancer in the United States (1).
PSA is a glycoprotein that is produced exclusively in the prostate. Men suffering from prostate conditions typically have an increased production of PSA, which causes an increase in blood PSA levels.
A simple blood test can be carried out to measure PSA levels. There is some controversy surrounding the use of the PSA test as a screening for prostate cancer.
When should you consider having a PSA test?
Since the risk of prostate cancer increases with age, it is recommended that men over the age of 50 should consider having a PSA test.
African American men and men with a family history of prostate cancer have a heightened risk of prostate cancer. Therefore, these men should consider having a PSA test at the age of 45.
Benefits of PSA test
- It is a test with very few immediate side effects.
- Having a PSA test can lead to earlier detection of prostate cancer.
PSA test drawbacks
- However, there are some limitations of the PSA test. There are many things you should consider before having a PSA test.
- A PSA test is unable to distinguish between different causes of a rise in PSA. Prostate cancer, benign prostatic hyperplasia (BPH) and prostatitis can all cause a rise in PSA. Also, PSA levels increase with age as the prostate increases with age.
- A PSA test is also unable to distinguish which men diagnosed with prostate cancer who will benefit from treatment and who would not. Therefore, further tests will be required.
- Those with an elevated PSA are likely to undergo a biopsy. Nearly 70% of men that are offered a biopsy will have no sign of prostate cancer.
- Therefore, the PSA test can lead to having an unnecessary invasive procedure that can cause a serious infection.
Alternative to biopsy
Magnetic Resonance Imaging (MRI) is a non-invasive alternative to biopsies. An MRI test provides information on prostate volume and the stage and size of lesions within the prostate. The use of MRI can reduce the number of men undergoing unnecessary biopsies by 25% (3).
Prostate cancer diagnosis
90% of those diagnosed with prostate cancer will choose to have some form of treatment. This includes surgery, radiation therapy, or androgen deprivation. All of these treatments may be associated with adverse effects, such as urinary, bowel and erectile dysfunction.
Alternative to prostate cancer treatments
Treatment for prostate cancer may reduce the risk of advancing and spreading to other organs.
However, prostate cancer is a very slow growing compared to other cancers. The majority of men with prostate cancer do not die from prostate cancer.
This is shown in a study published in the New England Journal of Medicine (4). The study demonstrated that after 10 years, there were no differences in death rates in those that underwent prostate cancer treatments compared to those who elected to undergo active surveillance (4).
Unless you are suffering from an aggressive form of prostate cancer, active surveillance is the best option due to improved quality of life. You will not have to suffer from long-term side effects of prostate cancer treatment.
A review study recently published in the British Medical Journal found that PSA testing only slightly reduces the risk of dying from prostate cancer, but does not reduce the risk of death from all causes (2).
Therefore, taking a PSA test is not vital to your long-term health. If you decide to have a PSA test it is important to remember:
Avoid having a biopsy after a PSA test because this can cause a serious infection.
If you are diagnosed with prostate cancer you should remember it is typically a slow growing cancer. Choose active surveillance if you do not have an aggressive form of prostate cancer.
Active surveillance will prevent you from suffering the side effects of aggressive prostate cancer treatments.
- Barry MJ. Prostate-specific–antigen testing for early diagnosis of prostate cancer. New England Journal of Medicine. 2001 May 3;344(18):1373-7.
- Ilic D, Djulbegovic M, Jung JH, Hwang EC, Zhou Q, Cleves A, Agoritsas T, Dahm P. Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. BMJ. 2018 Sep 5;362:k3519.
- Ahmed HU, Bosaily AE, Brown LC, Gabe R, Kaplan R, Parmar MK, Collaco-Moraes Y, Ward K, Hindley RG, Freeman A, Kirkham AP. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. The Lancet. 2017 Feb 25;389(10071):815-22.
- Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, Davis M, Peters TJ, Turner EL, Martin RM, Oxley J. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. New England Journal of Medicine. 2016 Oct 13;375(15):1415-24.
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