The prostate-specific antigen (PSA) is a protein seen in both healthy and ill men. High levels of PSA may indicate prostate cancer, said Marshfield Clinic Health System oncologist/hematologist Dr. Chady Leon.

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 this is very controversial to say the least.

“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 screening 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 grow slowly. Early detection may lead to treatments that may not improve your outcome or life expectancy.

A significant portion of prostate cancers are slow growing. This means early detection does not lead to a decrease in the patient’s quantity or quality of life. Slow growing prostate cancers are not going to bother the patient,” Leon said.

Two large studies were conducted in the last 30 years to answer the question whether PSA screening saves lives from prostate cancer. The U.S.-based PLCO trial showed no benefit. The European ERSPC trial showed decreased mortality from prostate cancer in men who underwent screening. A most recent British trial did not show benefit. When looking at these trials, the details are important.

Cancer treatment can be grueling. Men may have their quality of life worsened for the sake of treatments they sometimes do not need. Erectile dysfunction and urinary incontinence are common complications of prostate cancer treatments.

Who should get it

On the other hand, prostate cancer is a very common disease. It is the most common cancer in men, and the second most common cancer killer, second to lung cancer. It is responsible for close to 30,000 deaths per year in the U.S.

Leon does not recommend all patients have the PSA test. However, he recommends a discussion between the patient and his primary provider to make that decision about PSA screening. Patient’s values, goals and preference should all be taken into account. This is also in line with recommendations from major medical societies.

“That’s my opinion, and other doctors may differ,” Leon said. “These general screening recommendations do not pertain to certain populations.”

If you are at high risk for prostate cancer, Leon would recommend a PSA test. Common risk factors include:

• Individuals who are African American
• Those with a family history of the disease
• Those with a known gene that can cause prostate cancer like BRCA1 or BRCA 2

For otherwise healthy men, Leon said the PSA test should be discussed with their provider.