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Should You Get a PSA Test for Prostate Cancer?

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Scott Johnson, MD

Fellowship-Trained Urologic Oncologist

Froedtert & the Medical College of Wisconsin Cancer Network

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Prostate cancer is the most commonly diagnosed cancer in men in the United States – in fact, more than 160,000 men are estimated to be diagnosed and more than 26,000 men will die of the disease this year. Fortunately, it can be found during the earliest and most treatable stages – thanks to screening with a prostate-specific antigen (PSA) test.

A PSA test is a blood test that measures the amount of PSA in your blood. PSA is a protein produced by cancerous and noncancerous tissue in the prostate gland, which is located below the bladder in men. There has been significant controversy surrounding the use of PSA for prostate cancer screening. This is because prostate cancer can be found in its early stages with PSA testing, but the PSA level can be elevated for a variety of reasons in addition to the presence of cancer. A suspicious PSA test result can lead to other tests and possible treatment for prostate cancer.

A digital rectal exam may be part of the screening. This exam involves your doctor gently inserting a gloved, lubricated finger into the rectum and palpating the prostate gland to check for abnormalities. For instance, a tumor can often be felt as a hard lump. During this exam, your doctor may also use the other hand to gently press on the lower belly or pelvic area.

Before getting screened for prostate cancer with a PSA test, it’s important to have a discussion with your physician about the expectations and consequences of further diagnostic tests. Then, together, decide if screening is right for you. Men at average risk for prostate cancer should have that discussion at age 55. If you’re at high risk, have the conversation at age 45. High risk includes African-American men and men who have a first-degree relative (father, brother or son) diagnosed with prostate cancer at an early age – younger than age 65. And if you’re at even higher risk – you have more than one first-degree relative who had prostate cancer at an early age – talk with your doctor about screening at age 40.

If your prostate screening results show elevated PSA levels, the next step is a biopsy. From there, your physician may find no cancer, low-risk cancer that can be watched and may not need treatment — or more significant cancer that should be treated.

Although the PSA blood test itself has minimal risks, it can lead to important downstream effects of more men undergoing treatment for prostate cancer than necessary. Often, men will be diagnosed with low-risk prostate cancer, which may never need to be treated — a man might have prostate cancer but still live a full life without experiencing any symptoms or side effects. The critical issue is determining which prostate cancers are the most harmful and who needs to be treated. That’s why it’s important to consult with a physician who specializes in prostate cancer and has the dedicated expertise to help you make the right decision.

The good news is that more significant prostate cancer is treatable. Localized prostate cancer (cancer that has not spread beyond the prostate gland) is usually treated with radiation therapy or surgery to remove the cancer. Surgical options include open and robotic prostatectomy (removal of the prostate gland). Surgery is typically well tolerated, and patients usually go home the next day with minimal pain. More advanced prostate cancer may be treated with additional options such as hormonal therapy, chemotherapy or combination treatment. Whichever option is chosen, it’s important to choose a specialist with extensive experience in that option.

If you have been diagnosed with prostate cancer, it’s also important to work with a care team that focuses on prostate cancer and has a lot of experience with treating the disease. Choose a team that is up-to-date on the latest prostate cancer research and participates in and publishes prostate cancer research. Your chosen team should be current on the most advanced treatments and technologies and should thoroughly outline a care plan that takes into account your health and quality of life goals.

To find a physician and team that specializes in prostate cancer and can guide you through PSA tests for prostate cancer and beyond, reach out to your health insurance provider.

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