Prostate cancer screening: Should I have a PSA test?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Prostate cancer screening: Should I have a PSA test?

Get the facts

Your options

  • Have a PSA test to check for prostate cancer.
  • Do not have a PSA test to check for prostate cancer.

Key points to remember

  • Many men who are older than 50 have this test as part of their regular checkups. But experts disagree on whether PSA tests should be recommended for all men.
  • There are other causes of a high PSA level besides prostate cancer. After receiving a high PSA result, men often have more testing and then find that cancer is not the cause.
  • Prostate cancer usually grows slowly. In some cases, it never affects a man's health.
  • Sometimes prostate cancer grows or spreads quickly. Unless it is treated, it leads to death.
  • Prostate cancer that is found early can usually be cured.
  • Treatment for prostate cancer can cause serious side effects (loss of bladder control, not being able to have an erection). If you have a PSA test and it leads to a diagnosis of prostate cancer, you'll face a hard decision about whether to have treatment and deal with its side effects.
  • After an abnormal PSA test, your next choice is to have a biopsy to look for signs of prostate cancer. If you learn that you have cancer, you then make choices about treatment.
  • If you have a family history of prostate cancer, your risk of getting it is higher than average.
FAQs

What is prostate cancer?

Prostate cancer is the abnormal growth of cells in the tissues of the prostate gland. It is the most common cancer in men. Most men who get it are older than 65.

Unlike many other cancers, it is usually slow-growing. Most men will die with prostate cancer but not because of prostate cancer.1 This doesn't mean that you will get it. Each person is different, and tests can't show who will get prostate cancer and who won't.

Early prostate cancer usually doesn't cause symptoms. When prostate cancer is found early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate. As prostate cancer grows or spreads, symptoms may develop, including urinary problems (such as blood in the urine) and bone pain.

If your father, brother, or son has had prostate cancer, your chances of getting it are higher than average.2 Men whose families carry the gene changes that cause breast cancer (BRCA1 or BRCA2) are thought to have a higher risk for prostate cancer.3 African-American men have higher rates of prostate cancer and are more than twice as likely to die from it as men in other racial and ethnic groups in the United States.3

What is a PSA test?

The prostate-specific antigen (PSA) test is a blood test. PSA is released into a man's blood by the cells of his prostate gland. Low amounts of PSA may be found in the blood of healthy men. The amount of PSA in the blood normally increases as a man's prostate enlarges with age. And it increases after ejaculation and after trauma to the prostate caused by such things as a long bike ride. It is also increased by inflammation of the prostate gland (prostatitis) and by prostate cancer.

The PSA test is usually done along with a digital rectal exam. Together they can help identify men who may have prostate cancer and should consider further tests.

What kind of results can a PSA test show?

A high PSA result can be the first warning sign of prostate cancer. A high PSA can signal a higher risk of getting prostate cancer in the future.4 But a high PSA can also be linked to other causes that aren't cancer.

The amount of PSA in the blood normally increases as a man's prostate enlarges with age. But when you have prostate cancer, your PSA level increases even more over time.

The PSA test and digital rectal exam can suggest a problem when there is not one. This is called a false-positive result. Only about 20 to 30 out of 100 men who have a PSA test result greater than 4.0 ng/mL actually have prostate cancer, while 70 to 80 of them don't have prostate cancer.

These tests may also fail to detect a problem when there is one. This is called a false-negative result.

What does the PSA test NOT tell you?

The prostate naturally gets bigger as a man gets older. More than half of all men who are older than 50 have an enlarged prostate. This affects the PSA level, making it less accurate as a way to detect cancer.

Because several other things can make a PSA level go up—for example, ejaculation or an infection in the prostate—your doctor may advise you to have another PSA test later before you make any further decisions.

If your PSA test suggests that you may have prostate cancer, your doctor may recommend a biopsy, which is the only way to make sure that you have prostate cancer. If the biopsy finds cancer, you must decide how or whether to treat it.

A few prostate cancers grow fast. Men who have fast-growing cancers are more likely to die from prostate cancer than men who have slower-growing cancers. A PSA test can't accurately tell which type of prostate cancer a man has. But in men who have not been diagnosed with prostate cancer, PSA velocity can show that there is a problem that needs further testing. PSA velocity is measured by looking at the rate of change in PSA levels over 2 or 3 years. PSA levels rise faster in men with prostate cancer than they do in men with enlarged prostates.

How does age affect the decision to have a PSA test?

Your chance of getting prostate cancer increases as you age. Men who are younger than 75 and who do not have serious health problems may gain the most from early detection and treatment.

What do the experts recommend?

Most medical experts say that men age 50 or older should talk to their doctors about the pros and cons of PSA testing so that they can make their own decisions.

Some experts worry that PSA testing for prostate cancer begins a process that can force a man to make hard decisions and can lead to other health problems that are caused by the treatment for prostate cancer. Here's what some experts say:

  • The U.S. Preventive Services Task Force (USPSTF) and most medical groups say most men should not be given PSA tests as part of routine medical checkups. Instead, each man should talk to his doctor to see if he should have the test.
  • The American Cancer Society recommends that if you are in good health and expect to live at least 10 more years, you should be offered annual PSA tests beginning at age 50.
  • The American Cancer Society recommends testing if you are an African-American man who is 45 or older.
  • The American Cancer Society says you could start regular PSA testing at age 40 if you have several close relatives who had prostate cancer before age 65.
  • The USPSTF says that men who are 75 or older should not be tested and that younger men should discuss the pros and cons of PSA testing before being tested. The USPSTF also says that men younger than 75 with long-term medical problems or who expect to live less than 10 years are unlikely to benefit from testing.

Why might your doctor recommend a PSA test?

Your doctor might recommend a PSA test if:

  • You are in your 50s or 60s and are in good health.
  • Your doctor wants to keep track of changes in your PSA level.
  • You are an African American or a Jamaican of African descent, which means that you have a greater chance of getting the kind of prostate cancer that grows and spreads.
  • Your father, brother, or son got prostate cancer before age 65.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have a PSA test Have a PSA test
  • It's a simple blood test. A needle is used to take a sample of blood from your arm.
  • A PSA test can help find prostate cancer early, while it is small and usually curable.
  • Testing could lead you to hard decisions about further testing and treatment.
  • Testing could lead to cancer treatment that can cause loss of bladder control and not being able to have an erection.
Don't have a PSA test Don't have a PSA test
  • You have regular checkups that don't include this test.
  • You avoid testing that could lead to cancer treatment that can cause other health problems, especially loss of bladder control and not being able to have an erection.
  • You may have treatable prostate cancer without knowing it.
  • Sometimes prostate cancer grows quickly. If this type of prostate cancer it is not found early, it can shorten your life.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about having a prostate-specific antigen (PSA) test to screen for prostate cancer

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I have two children who are in high school right now, and both plan to go to college. It's important to me to provide for them and ensure that they have the money they need to finish their education. If I found out I had cancer, I would try any treatment that might offer me a chance to live longer, even if it has side effects. I'm going to have the PSA test.

Eric, age 56

For me, there is still too much uncertainty about the benefits of the PSA test. I tend to stay away from things that aren't yet proven to work, even when I know there is a chance that we might someday find out there is a benefit. I'm willing to take that chance. Because I want to avoid the risks of inexact test results and additional tests, I'm not going to have the test.

Mike, age 62

My health is great. I still run, play tennis, and travel a lot. At my age, you start to see friends getting sick and dying of one thing or another, and it makes you start to think about your own health more. I know that the PSA test isn't perfect, but I want to have every chance I can to treat cancer early if I have it.

Jacob, age 68

I've done some reading on this subject, and I know that I'm a lot more likely to die from my heart disease than from prostate cancer. Right now I'm focusing my efforts on controlling my blood pressure and cholesterol because I know that treating those things can help me live longer and better. I know that if I had the PSA test and it was high, I would just worry and be stressed out. That's not good for my heart either!

Pieter, age 67

If you need more information, see the topic Prostate Cancer.

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a PSA test

Reasons not to have a PSA test

I want to know if I have cancer in my prostate.

I don't feel the need to know if I have prostate cancer.

More important
Equally important
More important

Having prostate cancer and not treating it scares me more than the urinary and erection problems that cancer treatment may cause.

I worry that I might end up with urinary and erection problems if I have prostate cancer treatment.

More important
Equally important
More important

I would do anything to fight prostate cancer, even if the side effects of treatment affect my quality of life.

I think the additional testing and treatment that might follow a positive test result would do me more harm than good.

More important
Equally important
More important

I want to know if I have prostate cancer.

I don't want to know if I have prostate cancer, because it may never affect my health.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having a PSA test

NOT having a PSA test

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Should all men over 50 have regular PSA tests?

  • Yes No, that's wrong. Although many men older than 50 have this test as part of their regular checkups, experts disagree on whether PSA tests are necessary for all men.
  • No You're right. Although many men older than 50 have this test as part of their regular checkups, experts disagree on whether PSA tests are necessary for all men.
  • I'm not sure It may help to go back and read "Key points to remember." Although many men older than 50 have this test as part of their regular checkups, experts disagree on whether PSA tests are necessary for all men.
2.

Is it important to think about the side effects of prostate cancer treatment when making this decision?

  • Yes It's true. Prostate cancer treatment can cause loss of bladder control and not being able to have an erection. Having a PSA test could lead to your having to decide whether to have that treatment.
  • No Sorry, that's wrong. Prostate cancer treatment can cause loss of bladder control and not being able to have an erection. Having a PSA test could lead to your having to decide whether to have that treatment.
  • I'm not sure It may help to go back and read "Compare your options." Prostate cancer treatment can cause loss of bladder control and not being able to have an erection. Having a PSA test could lead to your having to decide whether to have that treatment.
3.

Can a PSA test help find prostate cancer early, when it is usually curable?

  • Yes You're right. When prostate cancer is found early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate.
  • No No, that's wrong. When prostate cancer is found early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate.
  • I'm not sure It may help to go back and read "What is prostate cancer?" When prostate cancer is found early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits and references

Credits
Author Bets Davis, MFA
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Adam Husney, MD - Family Medicine

References
Citations
  1. Frankel S, et al. (2003). Screening for prostate cancer. Lancet, 361(9363): 1122–1128.
  2. American Cancer Society (2006). Cancer Facts and Figures 2006, pp. 1–56. Atlanta: American Cancer Society. Available online: http://www.cancer.org/docroot/STT/stt_0.asp.
  3. National Institutes of Health (2007). Prostate cancer genetics: Fact sheet. Available online: http://www.nih.gov/about/researchresultsforthepublic.
  4. Aus G, et al. (2005). Individualized screening interval for prostate cancer based on prostate-specific antigen level. Archives of Internal Medicine, 165(16): 1857–1861.

Prostate cancer screening: Should I have a PSA test?

You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your options

  • Have a PSA test to check for prostate cancer.
  • Do not have a PSA test to check for prostate cancer.

Key points to remember

  • Many men who are older than 50 have this test as part of their regular checkups. But experts disagree on whether PSA tests should be recommended for all men.
  • There are other causes of a high PSA level besides prostate cancer. After receiving a high PSA result, men often have more testing and then find that cancer is not the cause.
  • Prostate cancer usually grows slowly. In some cases, it never affects a man's health.
  • Sometimes prostate cancer grows or spreads quickly. Unless it is treated, it leads to death.
  • Prostate cancer that is found early can usually be cured.
  • Treatment for prostate cancer can cause serious side effects (loss of bladder control, not being able to have an erection). If you have a PSA test and it leads to a diagnosis of prostate cancer, you'll face a hard decision about whether to have treatment and deal with its side effects.
  • After an abnormal PSA test, your next choice is to have a biopsy to look for signs of prostate cancer. If you learn that you have cancer, you then make choices about treatment.
  • If you have a family history of prostate cancer, your risk of getting it is higher than average.
FAQs

What is prostate cancer?

Prostate cancer is the abnormal growth of cells in the tissues of the prostate gland . It is the most common cancer in men. Most men who get it are older than 65.

Unlike many other cancers, it is usually slow-growing. Most men will die with prostate cancer but not because of prostate cancer.1 This doesn't mean that you will get it. Each person is different, and tests can't show who will get prostate cancer and who won't.

Early prostate cancer usually doesn't cause symptoms. When prostate cancer is found early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate. As prostate cancer grows or spreads, symptoms may develop, including urinary problems (such as blood in the urine) and bone pain.

If your father, brother, or son has had prostate cancer, your chances of getting it are higher than average.2 Men whose families carry the gene changes that cause breast cancer (BRCA1 or BRCA2) are thought to have a higher risk for prostate cancer.3 African-American men have higher rates of prostate cancer and are more than twice as likely to die from it as men in other racial and ethnic groups in the United States.3

What is a PSA test?

The prostate-specific antigen (PSA) test is a blood test. PSA is released into a man's blood by the cells of his prostate gland. Low amounts of PSA may be found in the blood of healthy men. The amount of PSA in the blood normally increases as a man's prostate enlarges with age. And it increases after ejaculation and after trauma to the prostate caused by such things as a long bike ride. It is also increased by inflammation of the prostate gland (prostatitis) and by prostate cancer.

The PSA test is usually done along with a digital rectal exam. Together they can help identify men who may have prostate cancer and should consider further tests.

What kind of results can a PSA test show?

A high PSA result can be the first warning sign of prostate cancer. A high PSA can signal a higher risk of getting prostate cancer in the future.4 But a high PSA can also be linked to other causes that aren't cancer.

The amount of PSA in the blood normally increases as a man's prostate enlarges with age. But when you have prostate cancer, your PSA level increases even more over time.

The PSA test and digital rectal exam can suggest a problem when there is not one. This is called a false-positive result. Only about 20 to 30 out of 100 men who have a PSA test result greater than 4.0 ng/mL actually have prostate cancer, while 70 to 80 of them don't have prostate cancer.

These tests may also fail to detect a problem when there is one. This is called a false-negative result.

What does the PSA test NOT tell you?

The prostate naturally gets bigger as a man gets older. More than half of all men who are older than 50 have an enlarged prostate. This affects the PSA level, making it less accurate as a way to detect cancer.

Because several other things can make a PSA level go up—for example, ejaculation or an infection in the prostate—your doctor may advise you to have another PSA test later before you make any further decisions.

If your PSA test suggests that you may have prostate cancer, your doctor may recommend a biopsy, which is the only way to make sure that you have prostate cancer. If the biopsy finds cancer, you must decide how or whether to treat it.

A few prostate cancers grow fast. Men who have fast-growing cancers are more likely to die from prostate cancer than men who have slower-growing cancers. A PSA test can't accurately tell which type of prostate cancer a man has. But in men who have not been diagnosed with prostate cancer, PSA velocity can show that there is a problem that needs further testing. PSA velocity is measured by looking at the rate of change in PSA levels over 2 or 3 years. PSA levels rise faster in men with prostate cancer than they do in men with enlarged prostates.

How does age affect the decision to have a PSA test?

Your chance of getting prostate cancer increases as you age. Men who are younger than 75 and who do not have serious health problems may gain the most from early detection and treatment.

What do the experts recommend?

Most medical experts say that men age 50 or older should talk to their doctors about the pros and cons of PSA testing so that they can make their own decisions.

Some experts worry that PSA testing for prostate cancer begins a process that can force a man to make hard decisions and can lead to other health problems that are caused by the treatment for prostate cancer. Here's what some experts say:

  • The U.S. Preventive Services Task Force (USPSTF) and most medical groups say most men should not be given PSA tests as part of routine medical checkups. Instead, each man should talk to his doctor to see if he should have the test.
  • The American Cancer Society recommends that if you are in good health and expect to live at least 10 more years, you should be offered annual PSA tests beginning at age 50.
  • The American Cancer Society recommends testing if you are an African-American man who is 45 or older.
  • The American Cancer Society says you could start regular PSA testing at age 40 if you have several close relatives who had prostate cancer before age 65.
  • The USPSTF says that men who are 75 or older should not be tested and that younger men should discuss the pros and cons of PSA testing before being tested. The USPSTF also says that men younger than 75 with long-term medical problems or who expect to live less than 10 years are unlikely to benefit from testing.

Why might your doctor recommend a PSA test?

Your doctor might recommend a PSA test if:

  • You are in your 50s or 60s and are in good health.
  • Your doctor wants to keep track of changes in your PSA level.
  • You are an African American or a Jamaican of African descent, which means that you have a greater chance of getting the kind of prostate cancer that grows and spreads.
  • Your father, brother, or son got prostate cancer before age 65.

2. Compare your options

  Have a PSA test Don't have a PSA test
What is usually involved?
  • It's a simple blood test. A needle is used to take a sample of blood from your arm.
  • You have regular checkups that don't include this test.
What are the benefits?
  • A PSA test can help find prostate cancer early, while it is small and usually curable.
  • You avoid testing that could lead to cancer treatment that can cause other health problems, especially loss of bladder control and not being able to have an erection.
What are the risks and side effects?
  • Testing could lead you to hard decisions about further testing and treatment.
  • Testing could lead to cancer treatment that can cause loss of bladder control and not being able to have an erection.
  • You may have treatable prostate cancer without knowing it.
  • Sometimes prostate cancer grows quickly. If this type of prostate cancer it is not found early, it can shorten your life.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

If you need more information, see the topic Prostate Cancer.

Personal stories about having a prostate-specific antigen (PSA) test to screen for prostate cancer

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I have two children who are in high school right now, and both plan to go to college. It's important to me to provide for them and ensure that they have the money they need to finish their education. If I found out I had cancer, I would try any treatment that might offer me a chance to live longer, even if it has side effects. I'm going to have the PSA test."

— Eric, age 56

"For me, there is still too much uncertainty about the benefits of the PSA test. I tend to stay away from things that aren't yet proven to work, even when I know there is a chance that we might someday find out there is a benefit. I'm willing to take that chance. Because I want to avoid the risks of inexact test results and additional tests, I'm not going to have the test."

— Mike, age 62

"My health is great. I still run, play tennis, and travel a lot. At my age, you start to see friends getting sick and dying of one thing or another, and it makes you start to think about your own health more. I know that the PSA test isn't perfect, but I want to have every chance I can to treat cancer early if I have it."

— Jacob, age 68

"I've done some reading on this subject, and I know that I'm a lot more likely to die from my heart disease than from prostate cancer. Right now I'm focusing my efforts on controlling my blood pressure and cholesterol because I know that treating those things can help me live longer and better. I know that if I had the PSA test and it was high, I would just worry and be stressed out. That's not good for my heart either!"

— Pieter, age 67

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a PSA test

Reasons not to have a PSA test

I want to know if I have cancer in my prostate.

I don't feel the need to know if I have prostate cancer.

More important
Equally important
More important

Having prostate cancer and not treating it scares me more than the urinary and erection problems that cancer treatment may cause.

I worry that I might end up with urinary and erection problems if I have prostate cancer treatment.

More important
Equally important
More important

I would do anything to fight prostate cancer, even if the side effects of treatment affect my quality of life.

I think the additional testing and treatment that might follow a positive test result would do me more harm than good.

More important
Equally important
More important

I want to know if I have prostate cancer.

I don't want to know if I have prostate cancer, because it may never affect my health.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having a PSA test

NOT having a PSA test

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Should all men over 50 have regular PSA tests?

  • Yes
  • No
  • I'm not sure
You're right. Although many men older than 50 have this test as part of their regular checkups, experts disagree on whether PSA tests are necessary for all men.

2. Is it important to think about the side effects of prostate cancer treatment when making this decision?

  • Yes
  • No
  • I'm not sure
It's true. Prostate cancer treatment can cause loss of bladder control and not being able to have an erection. Having a PSA test could lead to your having to decide whether to have that treatment.

3. Can a PSA test help find prostate cancer early, when it is usually curable?

  • Yes
  • No
  • I'm not sure
You're right. When prostate cancer is found early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
Author Bets Davis, MFA
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Adam Husney, MD - Family Medicine

References
Citations
  1. Frankel S, et al. (2003). Screening for prostate cancer. Lancet, 361(9363): 1122–1128.
  2. American Cancer Society (2006). Cancer Facts and Figures 2006, pp. 1–56. Atlanta: American Cancer Society. Available online: http://www.cancer.org/docroot/STT/stt_0.asp.
  3. National Institutes of Health (2007). Prostate cancer genetics: Fact sheet. Available online: http://www.nih.gov/about/researchresultsforthepublic.
  4. Aus G, et al. (2005). Individualized screening interval for prostate cancer based on prostate-specific antigen level. Archives of Internal Medicine, 165(16): 1857–1861.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Last Updated: October 9, 2009

Author: Bets Davis, MFA

Medical Review: Adam Husney, MD - Family Medicine

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