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Prostate-specific antigen (PSA) is a protein made in the prostate gland. It shows up in the blood. A man who has prostate cancer usually has a higher level of PSA in his blood. A PSA test checks that. Sometimes the test detects prostate cancer before it causes any symptoms. However, not all men with prostate cancer have high PSA levels.
In 1986, the Food and Drug Administration approved the PSA tests as a way to track cancer in men who already had it. Eight years later, the FDA approved it as a way to screen for cancer. For years, doctors and health officials urged all men older than 50 to have yearly PSA tests. That is no longer the case.
What Changed About PSA Recommendations
Some recent large studies suggest that the test may do more harm than good. This has caused the U.S. Preventive Services Task Force and the American Academy of Family Physicians to recommend against PSA testing as a routine screening tool for prostate cancer.
The reasons why include:
- Many men who have prostate cancer show a low PSA.
- Many men with a high PSA do not have prostate cancer. In fact, up to 80% of high PSA results are false positives (high PSA level but no cancer).
- About 90% of men who find out about their cancer through a PSA test and a biopsy end up opting for treatment. But, those treatments may not always be necessary. That could be the case if the cancer is slow growing and not life threatening.
- Men often have serious complications from treatment.
When the experts looked at the results from several major studies, they concluded that PSA screening saved very few lives. But, it led to many surgeries that were not necessary and to a significant number of serious complications.
PSA Testing Today
Despite all of this, PSA is still an option. For instance, what if that elevated PSA is yours? You might want to know. Prostate cancer is the second most common cancer in men, after skin cancer. It is also the second most deadly cancer in men, after lung cancer. The fact remains that a higher PSA level usually means a greater chance of having prostate cancer.
One option is to follow the recommendations of the American Cancer Society:
- Starting at age 50, talk with your doctor about the risks and benefits of PSA screening.
- If you are at higher risk for prostate cancer, for instance, if you are African American or you have a father or brother who had prostate cancer before age 65, talk with your doctor at age 45.
If you choose to have your PSA checked and it is high, your doctor will probably repeat the test. Your doctor will also do a finger exam of your prostate, called a digital rectal exam. If those results are not normal and your PSA stays high, or is rising, a biopsy may be an option. The bottom line on PSA screening is that the decision is between you and your doctor. The best way to make the right decision is to know the pros and cons.