By Dr. Jian Ma
As a urologist, one of the most frequent questions men ask me is whether they should have a PSA test. The PSA test — or prostate-specific antigen blood test — looks for the presence of this substance in the blood. If it’s elevated, it may indicate the presence of cancer. Many men, because of previous widespread recommendations by much of the medical community, view the test as a must-have.
But we now know that the pros and cons of having this test should be thoughtfully considered before a decision is made. Having the PSA can lead to a diagnostic biopsy procedure and treatment that can cause life-altering side effects and don’t seem to extend lives, according to recent studies of large populations.
So what do we know and what actions should men and their physicians take regarding the PSA? One of the most important things is to have a conversation with your doctor about this test. Here are some thoughts to begin
We diagnose 300,000 to 400,000 prostate cancers a year in this country, a little less than the number of breast cancers. From 80 to 90 percent of those who are diagnosed with this cancer will not die from it — even without any treatment.
It’s an age-related cancer. At age 60, about 30 percent of men have it. At age 80, almost 100 percent of men have this cancer. It’s basically part of a man’s aging.
The PSA test doesn’t distinguish between aggressive forms of prostate cancer that are more likely to be a serious health threat; and slow-growing forms. If an older man has this test, it will likely lead to a biopsy, which probably will find cancer. Since the majority of these prostate cancers are probably not life threatening, many men may receive unnecessary treatment simply because of anxiety. The side effects of this treatment are frequently impotence and incontinence.
Because the data are not very clear regarding the effectiveness of the PSA test, medical organizations don’t agree on guidelines regarding its use. For patients, it can be very difficult to decide on the right course.
Medical systems in other countries — including Canada — routinely cover preventive screening tests based on clear evidence that the tests prevent disease and save lives. It’s worth noting Canadian insurance doesn’t cover routine PSA screening, and their prostate cancer death rate and overall longevity are no worse than in the U.S.
There is a number of factors to consider before testing, such as family history and being African American.
Early stages of the cancer have virtually no symptoms, but you should see your doctor if you have difficulty urinating; frequent urination; or pain with urination, erection or ejaculation.
In my own practice, the best possible scenario regarding the PSA is that a decision about the test is the result of an informed conversation between my patient and me. Right now, we don’t have a failsafe screening method for the variety of prostate cancer that will shorten lives. So talk to your physician, and don’t assume that more medicine is better medicine.
Dr. Jian Ma is a board certified urologist with Group Health Medical Centers. Group Health is a consumer-governed, nonprofit healthcare system that integrates care and coverage with more than 1,000 physicians in 75 specialties at 25 medical centers across Washington.