• Should I have a PSA?
• Important Facts About Prostate Cancer
• What is the PSA test?
• Who is most likely to benefit from screening?
• Am I in a high-risk group?
• Your age may help guide your decision
• What are the limitations of the PSA test?
• What do national organizations recommend?
• What happens if you have a positive screening test result?
• Treatment Options
• Conclusion
• References

Prostate Specific Antigen Test (PSA)

Should I have a PSA?

Answers to questions about prostate cancer screening

There continues to be some controversy surrounding prostate cancer screening, including the role of PSA levels. If during a physical exam there is an abnormality such as a prostate nodule, most physicians will recommend a PSA test. The main question, however, is whether to have the test done when your prostate examination is normal. While this test might be beneficial, there can be some risk. In several years, we hope to have better scientific evidence to resolve the controversy that exists. Until then, the information that follows is intended to help you make a decision about whether to have the test done.
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Important Facts About Prostate Cancer

Studies have shown that as men age, most will develop tiny areas of cancer in their prostate gland. Following skin cancer, prostate cancer is the next most common form of cancer among men in the United States. However, many of these cancers grow very slowly and the men are never troubled by them. On the other hand, in some cases the cancer grows rapidly and can lead to disability, pain or death. Prostate cancer is the second leading cause of cancer deaths in U.S. men.
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What is the PSA test?

PSA stands for prostate specific antigen, a chemical produced by the prostate gland. Levels of PSA can be measured in the bloodstream. High levels of PSA are associated with several conditions of the prostate including harmless enlargement, inflammation or prostate cancer. In other words, one can have an elevated PSA level but not have prostate cancer.

When prostate cancer is detected very early, it is
unknown whether it will be the slow-growing or fast-growing type. There is concern that while early detection may save some men's lives, others will be exposed to harmful risks and side-effects of treatment they don't need.
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Who is most likely to benefit from screening?

If early detection of prostate cancer improves health outcomes, the population most likely to benefit will be men between 50 and 70 who are at average risk and men older than 45 who are at increased risk.
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Am I in a high-risk group?

African-American males and those with a family history of prostate cancer (particularly that which occurred at a relatively young age) are at higher risk for prostate cancer.
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Your age may help guide your decision

What if you are not in a high-risk group and have a normal prostate exam? Based on our current knowledge, the following age groupings are suggested:

Ages 50 to 70: Potential benefit may outweigh the risk. Consider having the test done. The risk/benefit ratio probably becomes less favorable as you enter your early 70s.
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What are the limitations of the PSA test?

You should know some facts about the PSA test before making a decision. Here are some things to consider:

1. A mildly elevated PSA level is unlikely (less than 30 percent chance) to be associated with prostate cancer.


2. The higher the PSA, the more likely the chance of finding cancer.


3. PSA levels cannot reliably distinguish between slow-growing and fast-growing prostate cancers.


4. The use of PSA as a screening test has not been proven to prevent death or suffering from prostate cancer.

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What do national organizations recommend?

Most major U.S. medical organizations recommend that clinicians discuss with patients the potential benefits and possible harms of PSA screening, consider patient preferences, and individualize the decision to screen. They generally agree that the most appropriate candidates for screening include men older than 50 and younger men at increased risk for prostate cancer but that screening is unlikely to benefit men who have a life expectancy of fewer than 10 years. These organizations include the American Academy of Family Physicians, the American Cancer Society, the American College of Physicians-American Society of Internal Medicine, the American Medical Association and the American Urological Association.
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What happens if you have a positive screening test result?

If either the PSA test or digital rectal exam is abnormal (positive), a biopsy of the prostate may be done. If cancer if confirmed by biopsy, you will need to consult with your doctor and make a decision regarding treatment.
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Treatment Options

Treatment of prostate cancer is individualized and depends on a man's age, health, and the stage or
extent of his cancer. Options for treatment include:

1. Watchful waiting - which is choosing to monitor your health and only treating if symptoms develop. This might be appropriate for elderly men with slow growing tumors.


2. Radiation treatment, an option for both the cure and control of localized cancer.


3. Surgery (radical prostatectomy) for those men with "organ contained" cancer.


4. Male hormone therapy, which is often used for patients whose cancer is not responsive to other forms of treatment.

All of these treatments may have significant risks such as impotence, incontinence and a small chance of death.
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Conclusion

Consulting with your doctor and making sure you understand all the facts will help in deciding whether or not to have a PSA. Your age may be an important factor to consider.

This information has been provided to inform you about the risks and benefits of prostate cancer screening to help you make a decision about having a PSA test.
If you have any questions or concerns about screening for prostate cancer not answered by this pamphlet, please talk with your doctor.

Authors: Steven Carlson, M.D., and Arnold Aigen, M.D.
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References

Harris RP, Lohr KN. Screening for prostate cancer: an update of the evidence for the US Preventive Services Task Force. Ann Intern Med. 2002; 137: 917-29.

Screening for Prostate Cancer: Recommendation and Rationale. US Preventive Services Task Force. Ann Int Med 2002;137:915-916.

Prostate-specific antigen (PSA) best practice policy. American Urologic Association (AUA). Oncology (Huntinngt). 2002;14:267-72.

Related Web sites:
National Cancer Institute. Accessed March 2004.

American Cancer Society. Accessed March 2004.

American Urological Association. Accessed March 2004.
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