It\u2019s a simple blood test that can help detect a common cancer well before any symptoms. Yet the prostate-specific antigen test, or PSA, remains controversial.<\/p>\n
Men should not undergo this test without first discussing it with their health care providers.<\/p>\n
To understand why, MultiCare Health System urologist Douglas Sutherland, MD, says you need to understand both the test itself and the disease it\u2019s designed to detect \u2014 prostate cancer.<\/p>\n
\u201cIt is not invasive at all,\u201d Dr. Sutherland says of the PSA screening.<\/p>\n
Unlike a colonoscopy or a mammogram, it doesn\u2019t require any additional procedures or preparation, Dr. Sutherland says. Consequently, it is often added to routine annual labs without the patient even knowing about it.<\/p>\n
And\u00a0yet five years ago, the U.S. Preventive Services Task Force, the government committee that advises Medicare, gave the PSA a \u201cD\u201d grade, meaning they recommended against it.<\/p>\n
This year, as part of its routine evaluation cycle, the Task Force is expected to raise the grade back to a \u201cC\u201d for men ages 55\u201370. A \u201cC\u201d grade means they recommend that physicians offer the test in select cases based on their discretion and patient preference.<\/p>\n
Dr. Sutherland says the Task Force recommendation comes, in part, because the test can\u2019t actually detect cancer.<\/p>\n
\u201cThe PSA blood test can only provide an estimate of risk for a given man,\u201d he says. \u201cAnd we\u00a0now know the PSA test is very inaccurate.\u201d<\/p>\n
There is a significant rate of \u201cfalse positives\u201d in which high PSA levels indicate potential cancer when there is none.<\/p>\n
Still, we\u2019re talking about cancer, so false positives probably seem like a small price to pay for potentially catching the disease early, right?<\/p>\n
That\u2019s not necessarily true, Dr. Sutherland says, for two reasons. The first is that the next step is much more invasive and unpleasant. If a man has a high PSA level, he must undergo a prostate biopsy to be sure. The procedure only takes about five minutes and carries a small risk of bleeding and infection. But for most men, that\u2019s not the worst part.<\/p>\n
\u201cIt is considered very uncomfortable,\u201d Dr. Sutherland says.<\/p>\n
But if you find prostate cancer, that makes it worthwhile, right? That\u2019s the second reason routine PSA screening isn\u2019t the standard of care. Not all prostate cancers are equal, and in fact, most are slow-growing and unlikely to cause any problem.<\/p>\n
But once discovered, many men will choose to treat their cancer. And with slow-growing prostate cancer, the cure can be worse than the disease.<\/p>\n
\u201cThey will suffer\u00a0all of the consequences of the treatment \u2014 such as sexual and urinary dysfunction \u2014 with no benefit,\u201d Dr. Sutherland says of men who discover slow-growing, \u201charmless\u201d prostate cancer as a result of routine screening.<\/p>\n
\u201cThat really depends on the individual man and his specific goals,\u201d Dr. Sutherland says.<\/p>\n
While most men develop prostate cancer late in life when the slow-growing disease simply doesn\u2019t have time to cause problems, \u201cfor young, healthy men, with a long life expectancy, an earlier diagnosis is in fact a life-saving event.\u201d<\/p>\n
Dr. Sutherland says it is \u201cmost critical\u201d that men discuss their individual risk factors with their doctor and make an informed decision about whether or not to have a PSA screening.<\/p>\n
\u201cThose at highest risk for developing serious prostate cancer are men with a first-degree relative with prostate cancer (father, brother) and those men of African descent,\u201d he says.<\/p>\n
Lifestyle also seems to be a factor with obesity, high-fat diets, smoking and lack of exercise associated with more aggressive forms of prostate cancer, although the direct cause and effect mechanism isn\u2019t known.<\/p>\n
Testosterone-replacement therapy has been feared by some to potentially cause or worsen prostate cancer, but \u201cthis concern is increasingly felt to be inaccurate,\u201d Dr. Sutherland says.<\/p>\n
Unfortunately, prostate cancer rarely shows any signs or symptoms before it has spread, Dr. Sutherland says.<\/p>\n
Unexplained weight loss, lack of appetite, difficulty urinating or blood in the urine are typical, along with pain to the site where the cancer has spread \u2014 it frequently spreads to the bone.<\/p>\n
Any of these symptoms warrant a discussion with your doctor.<\/p>\n