Any irritation of the prostate, via infection or even a prostate exam, can elevate PSA levels. This means high PSA numbers do not always indicate prostate cancer.
Debate over having the PSA test
It seems logical that any man in the age range for prostate cancer, typically 40 and older, should have a PSA blood test. Leon said that is not necessarily the case.
“I don’t think there’s an area of medicine that is more controversial or debated than this topic of whether men should have this test,” Leon said. “For otherwise healthy men, there is no uniform recommendation as to having the test or not.”
What’s the harm in taking the test?
False positives from PSA tests are possible and can lead to unnecessary medical interventions, Leon said. In addition, most prostate cancers are slow growing. Early detection may lead to invasive medical interventions that do not improve a patient’s prognosis or life expectancy.
“The majority of prostate cancers are so slowly growing that it doesn’t matter if you detect it earlier or later. The patient is not likely to die from the cancer,” Leon said.
Delaying a PSA test may protect a patient’s quality of life. Cancer treatment is grueling, and men can live long periods of time without prostate cancer advancing significantly. Erectile dysfunction and urinary incontinence are common complications of prostate cancer treatments.
“Men may have their quality of life worsened for the sake of treatments they don’t need,” Leon said.
Dr. Leon does not recommend all patients of a certain age have the PSA test.
“That’s my opinion, and other doctors may differ,” Leon said. “For patients with high risk factors for prostate cancer, like African Americans or those with a family history of the disease, I would recommend a PSA test,” Leon said.
For otherwise healthy men, Leon said the PSA test should be discussed with their provider.
While most prostate cancers are slow growing, there are exceptions, which progress rapidly. There are about 130 new cases of prostate cancer for every 100,000 men each year.