PSA testing a personal decision based on risk factors

Q: Who should be screened for prostate cancer?

A: Prostate cancer screening is controversial, including the age at which men should begin prostate-specific antigen (PSA) testing, a blood test that screens for early signs of the disease. Although screening has contributed to lower mortality from prostate cancer, there is the risk of overdetection of nonaggressive cancers and overtreatment. So most guidelines recommend men discuss this with their doctor. For men with no risk factors, the American Urologic Association doesn't recommend testing until age 55.

If you have a family history or other risk factors, consider getting a baseline PSA and a digital rectal exam at a younger age. Your baseline can help your doctor interpret future PSA levels.

A normal PSA test and digital rectal exam can reassure you that your odds of having prostate cancer are low. But a PSA test may not be beneficial for some men, especially those 70 and older, or any man with less than a 10- to 15-year life expectancy.

Elevated PSA levels don't always equal prostate cancer. Your PSA level can be elevated when cancer isn't present, and normal when cancer is present. Also, some prostate cancer is so slow-growing that it may never require care. In these cases, "active surveillance" may be recommended. This allows the monitoring of small, slow-growing cancer that is not causing any symptoms and is contained within the prostate. Care can begin if the cancer seems to be growing or worsening.

Not everyone needs an annual PSA. Men who are considering a screening should discuss the pros and cons with their doctor.

- Dr. John M. Smyles