Getting Tested

Prostate-specific antigen, or PSA, is a protein produced by cells of the prostate gland. There is no specific normal or abnormal level of PSA in the blood. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present. However, more recent studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer.

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The PSA test measures the level of PSA in a man’s blood. For this test, a blood sample is sent to a laboratory for analysis. This test can be done at home or in a doctor’s office.

The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the FDA in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, the FDA approved the use of the PSA test in conjunction with a digital rectal exam (DRE) to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing (along with a DRE) to help doctors determine the nature of the problem.

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Here’s the opinion of several highly-respected medical organizations:

The American Cancer Society recommends that men discuss the need for a PSA test with their doctors at the following times:

  • at age 50, if the man has an average risk of prostate cancer and can be expected to live at least another 10 years;
  • at age 45, if the man has a high risk of prostate cancer. This includes African-Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
  • at age 40, if the man has a very high risk (more than one first-degree relative diagnosed with prostate cancer younger than 65).

The National Cancer Institute notes that a PSA test may have a “false positive” or “false negative” result. A false-positive result means that the PSA level is high, but the man does not actually have cancer. As a result, he may have to have more tests that are unnecessary and may be harmful. A false-negative test means that even though the PSA level is low, the man actually does have cancer. The low PSA level may give him a false sense of security.

The American Urological Association recommends against routine screening for men under the age of 55 who are at average risk; for men in this age group who are at higher risk, the decision to have a PSA test should be considered on a case-by-case basis. For men between the ages of 55 and 69, the recommendation is to discuss the PSA test with the physician, taking into account the man’s overall medical condition and preferences.

So what does that mean for you??

Screening can mean early detection. So, for some men, the PSA screening test can be a lifesaver. You and your doctor must work together to make an informed decision on PSA testing. If you do choose to have the PSA screening test, make sure you have it along with the digital rectal exam. Having both screening tests is the most likely way not to miss a cancer.

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