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Prostate Cancer Screening: Is the PSA Test for You?

Posted on Oct 9, 2014

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Prostate cancer is the most common cancer among men (after skin cancer). Although it is a serious disease, it can often be treated successfully. More than 2 million men in the United States are prostate cancer survivors, according to the American Cancer Society.

Prostate cancer occurs mainly in older men. About 6 cases in 10 are diagnosed in men aged 65 or older, and it is rare before age 40. The average age at the time of diagnosis is about 66.

The American Cancer Society’s estimates for prostate cancer in the United States for 2014 are:

  • About 233,000 new cases of prostate cancer will be diagnosed
  • About 29,480 men will die of prostate cancer
  • About 1 man in 7 will be diagnosed with prostate cancer during his lifetime.

Prostate Cancer Screening: Should You Get the PSA Test?

The Prostate Specific Antigen (PSA) Test is a test used for prostate cancer detection. Until recently, many doctors and professional organizations such as the Amercian Urological Association, encouraged yearly PSA screening for men beginning at age 50. However, as more has been learned about both the benefits and harms of prostate cancer screening, many organizations, including the U.S. Preventive Services Task Force (USPSTF), have changed their recommendations and no longer recommend annual PSA screening for prostate cancer.

In this blog post, Simon Kimm, M.D., a urologist at the Palo Alto Medical Foundation, explains the change in PSA prostate cancer screening recommendations, and suggests some guidelines to consider when speaking with your doctor about whether to have a PSA screening.

“Starting in the 1990s, the use of the Prostate-Specific Antigen (PSA) Test revolutionized our ability to detect prostate cancer,” Dr. Kimm says. “Detection increased, during a time when new techniques in surgery and radiation therapy were being developed. This lead to a period of widespread and aggressive treatment of prostate cancer. Studies show this approach saved lives, but it also subjected many men to the side-effects of treatment.

“Over the past ten years, we have learned from studies, that a smaller number of prostate cancers behave very aggressively. Some pose more intermediate risk, and many are low risk and unlikely to be life-threatening. We also have learned that PSA alone is not always a good test for discriminating between these types of prostate cancers.”

We now understand that the harms and benefits of screening should be balanced for each individual, Dr. Kim says. “Screening should be focused on men who have the highest risk of life-threatening prostate cancer. Even after prostate cancer is diagnosed, immediate treatment is not always required. Men with low-risk prostate cancer can be observed in a program of active surveillance. By working closely and being judicious in screening and treatment of this disease, doctors and patients can together find a balance between the benefits and potential harms of PSA screening for each man.”

Based on the best available evidence, the American Urologic Association has released guidelines for PSA screening for prostate cancer:

  • Routine screening in men younger than age 55 without significant risk factors for prostate cancer is not recommended.
  • Men older than age 70 benefit the least from screening, and men with a less than a 10 to 15 year life expectancy should not be screened.
  • Men between age 55 and 69 stand to benefit the most from screening, and each should have an informed discussion about the benefits and harms before being offered this testing.

Kimm-Simon-2014 Simon Kimm, M.D. is a urologist at the Palo Alto Medical Foundation.