PSA testing: When should you consider it?

The topic of when to have a Prostate-Specific Antigen (PSA) test is crucial for many men, particularly as they grow older. The PSA test is a blood test primarily used to screen for prostate cancer by measuring the level of PSA in the blood. While the PSA test can help detect early signs of prostate cancer, the decision to take this test should be made after careful consideration and discussion with a healthcare provider. In his latest online article, Mr Ashwin Sridhar explores key considerations and guidelines to help decide when it might be appropriate to have a PSA test.

Understanding PSA testing

Before diving into when to have a PSA test, it's important to understand what the test involves and its implications. The PSA test is simple, requiring just a blood sample, but interpreting the results can be complex. Elevated PSA levels can indicate prostate cancer but can also be caused by other conditions, such as an enlarged prostate (benign prostatic hyperplasia) or a prostate infection (prostatitis).

Age considerations:

• The American Cancer Society suggests that men with an average risk of prostate cancer should discuss screening with their healthcare provider at age 50.

• Men at high risk, including African American men and those with a first-degree relative (father or brother) diagnosed with prostate cancer before age 65, should have this conversation at age 45.

• Men at even higher risk, with more than one first-degree relative who had prostate cancer at an early age, should start discussing screening options at age 40.

Personal risk factors:

Besides age and family history, other factors may influence the decision to undergo PSA testing. These include genetic predispositions and lifestyle factors. Individuals with inherited conditions, such as Lynch syndrome, or those with a strong family history of other cancers, may need to consider earlier or more frequent testing.

Symptoms:

While PSA testing is primarily considered a tool for early detection in asymptomatic men, those experiencing symptoms associated with prostate problems, such as difficulty urinating, blood in urine or semen, or pelvic discomfort, should consult a healthcare provider, who may recommend a PSA test among other diagnostic tests.

Discussing pros and cons:

The decision to undergo PSA screening should follow an informed discussion with a healthcare provider about the potential benefits and risks. Benefits include early detection of prostate cancer, which can be critical for effective treatment and management. However, risks involve false positives (leading to unnecessary anxiety and procedures) and overdiagnosis (identifying cancers that may never cause symptoms or pose a health threat).

Follow-up and frequency:

If you decide to undergo PSA screening and the results are normal, your healthcare provider will recommend the frequency of future tests based on your initial PSA level and risk factors. Men with elevated PSA levels may need additional testing, such as a digital rectal exam (DRE) or a prostate MRI, and possibly a biopsy to confirm the presence of cancer.

Making the decision

Ultimately, the decision to have a PSA test should be based on a personal assessment of risks and benefits in consultation with a healthcare provider. This decision is deeply personal and can vary significantly from one individual to another based on their risk factors, values, and preferences regarding their health and quality of life.

Mr Ashwin Sridhar is an esteemed urologist and robotic prostate and bladder cancer surgeon. You can schedule an appointment with Mr Sridhar on his Top Doctors profile.