Should I get a PSA Test?

Caregiving experts advise: should you get a PSA test?

The prostate-specific antigen, or PSA, test measures inflammation that can be elevated for many reasons other than cancer, such as normal enlargement of the prostate with age or an infection. As caregiving professionals, this is the advice we give people who ask whether or not they should get a PSA test:

Prostate cancer screening can help identify cancer early on, when treatment is most effective. And a normal PSA test, combined with a digital rectal exam, can help reassure you that it’s unlikely you have prostate cancer.

But getting a PSA test for prostate cancer may not be necessary for some men, especially men 70 and older.

Professional organizations vary in their recommendations about who should — and who shouldn’t — get a PSA screening test. While some have definitive guidelines, others leave the decision up to men and their doctors. Organizations that do recommend PSA screening generally encourage the test in men between the ages of 40 and 70, and in men with an increased risk of prostate cancer.

Researchers said over-diagnosis occurs when cancer is detected correctly but would not cause symptoms or death.

The main problems are false-positive results and over-diagnosis, the review indicated. A positive PSA test result often leads to more tests such as a biopsy, which carries risks of bleeding, infection, and urinary incontinence.

In most men with prostate cancer, the tumour grows slowly, and they are likely to die of another cause before the prostate tumour causes any symptoms.

Ultimately, whether you have a PSA test is something you should decide after discussing it with your doctor, considering your risk factors and weighing your personal preferences.

Two tests are commonly used to screen for prostate cancer:

Digital rectal exam (DRE): A doctor or nurse inserts a gloved, lubricated finger into the rectum to estimate the size of the prostate and feel for lumps or other abnormalities.

Prostate specific antigen (PSA) test: Measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.

Because many factors can affect PSA levels, your doctor is the best person to interpret your PSA test results.

What questions should you ask your Doctor or Urologist?

1. How accurate is PSA in detecting prostate cancer?

2. What percentage of patients with an elevated PSA have prostate cancer?

3. What are the alternatives to a prostate biopsy?

4. What percentage of patients with positive biopsies are positive for aggressive prostate cancer?

5. What if I am diagnosed with a low-grade (Gleason Score 6) form of prostate cancer? Is treatment recommended?

6. What percentage of your biopsies are negative or detect a low-grade prostate cancer for which no treatment is recommended?

With files from:

Mayo Clinic

Men’s Health Magazine

Prostate Cancer Canada

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