Many male patients question whether or not they should have the prostate specific antigen (PSA) test done. This simple blood test can detect prostate cancer at an early stage, but it is still unclear whether or not getting the PSA will benefit you.
Read on to learn more about the PSA test so that, armed with information, you can discuss your options with your doctor.
PSA Pros and Cons
According to statistics by the American Cancer Society, prostate cancer has become the number two cause of cancer death in men. Lung cancer remains number two.
Prostate cancer is very common. It has been estimated that 40% of all men over age 50 have it, but only about 8% of men ever get symptoms, and only 3% die of the disease. In other words, 4 out of 5 men with prostate cancer never get symptoms and 9 out of 10 will die of something else. In the past, most of these men never found out they had cancer.
The PSA test changed all that. Before the test went into widespread use – beginning in the mid-1980s – there were only about 1/3 as many cases diagnosed per year. Even so, the number of prostate cancer deaths was about the same as it is today.
This points out one of the biggest problems with PSA testing. Doctors now have the ability to detect cancer not just in those destined to die of the disease, but also in the majority who will never get symptoms. Unfortunately, it’s impossible to differentiate between the two groups – at least so far.
The second big problem with PSA testing is that it’s not clear that the standard treatments for prostate cancer – radical prostate surgery and X-ray therapy – save lives. Many doctors and patients assume that they do, but it’s still unclear how effective these are, and no studies have compared one treatment to the other. Even so, the number of men undergoing prostate surgery has skyrocketed.
The side effects of radical prostate surgery, such as impotence and incontinence, are significant. Though surgeons in top prostate cancer centers report better results, a survey of men 2 to 4 years after the operation found that only 11% had had an erection sufficient for intercourse in the prior month. Almost a third wore adult diapers or clamps on their penises to control their urine. Radiation therapy also has significant side effects.
There are major disagreements among medical authorities on PSA testing. The American Cancer Society says men should have one every year starting at age 50 (earlier if they’re African American or have a family history of prostate cancer). The US Preventive Services Task Force does not recommend routine screening.
The side effects of treatment for male patients over age 70 or whose life expectancy is less than 10 years simply outweigh the benefits. As for younger men, a PSA test could save their lives – or it could cause them a lot of needless grief. At this point no one can tell you for certain which.
Instead, patients should learn as much as they can about prostate cancer, by perhaps visiting their local library (and selecting books and resources that are no older than two years old).
Given the uncertainties, whether to have a PSA test is a highly personal decision – one each man must make in consultation with his doctor. As with any medical decision that hinges mostly on value judgments, however, it should be your values – not your doctor’s – that dictate what you do.