PSA stands for prostate specific antigen. This
protein can be detected in the blood using a simple blood test. High levels
could suggest the presence of prostate
, and therefore the test has been used to screen men for this cancer.
(Screening is done to check for the presence of an illness in a person who do
not have any symptoms so that the condition can be diagnosed and treated
early.) However, there are benign conditions that could also result in a rise
levels; therefore the test
does not confirm the presence of the cancer.
The PSA test has a few advantages when used as a
screening test. The patient has to undergo a blood test, in contrast to other
tests for prostate cancer like prostate biopsy. The cancer, if detected early,
can be completely cured.
There are also several disadvantages of doing the
PSA test. Since there are other benign conditions that could also result in a
rise in PSA, the test has a high chance of false positive results which could
subject the patient to a lot of anxiety
In addition, the patient may have to undergo further tests like prostate
biopsy, which may turn out to be quite unnecessary and put the patient at a
risk of suffering from complications from the procedures. It may also result in
diagnosis of cancers that may never have caused death in the patient.
The US Preventative Services Task Force (USPSTF) and
the American Academy of Family Physicians (AAFP) recommend against using PSA
testing as a screening test for prostate cancer.
The American Urological Association (AUA) does not
recommend routine screening with PSA in men below the age of 55 years, unless
they are at higher risk for prostate cancer, in which case the decision should
be individualized. Men between the ages of 55 and 69 years would probably
benefit the most from the screening, and therefore the test can be discussed
with the patient. The test may be repeated once in two years in these patients,
instead of annually, to reduce the chances of false positive results. Screening
is not recommended in those with a life expectancy of less than 10 to 15 years.
The American College of Physicians (ACP) recommends
that men between the ages of 55 and 69 should be informed about the limited
potential benefits and substantial possible harms of doing PSA testing. The
decision to do the test should be based on the risk of the individual patient,
result of the discussion, patient's preference and the general health and life
expectancy of the patient.
Thus, routine screening for all men with PSA test is
not recommended. Another test that could be more accurate could possibly fill
this gap in medical science in the future.
4. Amir Qaseem et al. Screening for Prostate Cancer: A Guidance Statement from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 2013;158(10):761-769.