PSA screening
Routinely screening all men to check their prostate-specific antigen (PSA) levels is a controversial subject in the international medical community.
In some countries, such as the US, all men over 50 are recommended to have an annual PSA test. However, many European countries, including the UK, do not offer routine PSA screening.
There are several reasons for this:
- PSA tests are unreliable and often produce results that suggest the presence of prostate cancer when no cancer exists (a false-positive result). This means that many men often have invasive and sometimes painful biopsies for no reason.
- Some experts question whether an early diagnosis of prostate cancer is actually worthwhile.
- While it is true that treating the condition in its early stages is normally more successful, the side effects of the various treatments are potentially so serious that men may choose to delay treatment until it is absolutely necessary.
- Although screening has now been shown to reduce a man’s chance of dying from prostate cancer, it increases his chances of being diagnosed with and treated for prostate cancer. It is not yet clear whether the benefits of screening outweigh the risks.
Because there are many reasons why PSA levels may be high at any one time, researchers are trying to make the PSA test, or a variation of it, more accurate. These include looking at how PSA levels change (or not) over time, and comparing the PSA level to prostate size. There is also a test that measures ‘free’ PSA. These variants of the PSA are still being investigated by clinical researchers. They are not standard tests in prostate disease.
There is an informed choice programme on prostate cancer risk management. It aims to give men good information on the pros and cons of a PSA test. If you decide to have your PSA levels tested even if you do not have any symptoms, your GP will be able to arrange it for you.
Should I have a PSA test?
Because the results of the PSA test are not as reliable as doctors would like, other tests and investigations are needed to diagnose prostate cancer. It cannot identify prostate cancer on its own, and changes in PSA levels alone are not a good reason to start treatment.
If you are going to have a PSA test, it is important that you first discuss with your GP whether it is right for you, so that you understand what the results might mean.
Want to know more?
