Prostate Cancer Screening: Should I Have a PSA Test?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Prostate Cancer Screening: Should I Have a PSA Test?

Get the facts

Your options

  • Have a PSA test to check for prostate cancer.
  • Do not have a PSA test to check for prostate cancer.

This decision aid is for men in their 50s and 60s who are thinking about having a PSA test to screen for prostate cancer. It is not for men who have been diagnosed with prostate cancer or are at high risk. If you don't already know your prostate cancer risk, you can ask your doctor.

Key points to remember

  • PSA tests can help find some prostate cancers early, when the cancer may be easier to treat. The largest study of prostate cancer screening so far showed that PSA testing may lower the risk of dying from prostate cancer in a small number of men.
  • A high PSA level can have many causes, including an enlarged prostate, an infection, or, less often, prostate cancer. A high PSA can cause a lot of worry and lead to more tests. But most high PSA tests will not turn out to be cancer.
  • Many cancers found by PSA tests would not have caused a problem if they had not been found through screening. But when they are found, they often get treated with radiation or with surgery to remove the prostate. These cancer treatments may not have been needed. And they can have serious side effects, such as urinary, bowel, and erection problems.
  • PSA testing increases the chance that you will be diagnosed with prostate cancer. This is because screening finds cancers that otherwise would never have been found. The chance of being diagnosed with cancer increases each time you have the test.
  • Many prostate cancers grow slowly. This means that many men with prostate cancer will die of something else before their prostate cancer advances enough to cause any problems.
  • With faster-growing prostate cancers, finding the cancer early may not help you live longer. Some prostate cancers will be fatal no matter when they are found.
FAQs

What is prostate cancer?

Prostate cancer is the abnormal growth of cells in the tissues of the prostate gland. It is the second most common cancer in men. Most men who get it are older than 65.

Early prostate cancer usually doesn't cause symptoms. When prostate cancer is found early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate. Or if the cancer is considered low-risk, active surveillance or watchful waiting is an option. As prostate cancer grows or spreads, symptoms may develop, including urinary problems (such as blood in the urine) and bone pain.

Many prostate cancers grow slowly. This means that many men with prostate cancer will die of something else before their prostate cancer advances enough to cause any problems. With faster-growing prostate cancers, finding the cancer early may not help you live longer. Some prostate cancers will be fatal no matter when they're found.

What is a PSA test?

The prostate-specific antigen (PSA) test is a blood test that measures your level of PSA. The PSA test is usually done to screen for prostate cancer in men who have no symptoms.

PSA is released into a man's blood by the cells of his prostate gland. A PSA test can show if you have normal or high amounts of PSA in your blood. A high PSA level can have many causes, including an enlarged prostate, an infection, or, less often, prostate cancer.

What are the benefits of having a PSA test?

PSA tests can help find some prostate cancers early, when the cancer may be easier to treat. The largest study of prostate cancer screening so far showed that PSA testing may lower the risk of dying from prostate cancer in a small number of men.

But experts disagree on how useful PSA testing is. For many men, it may not help them live any longer than if they'd had no screening.

What are the risks of having a PSA test?

False-positive results

Often the PSA test can show high levels of PSA that aren't caused by cancer (called a false-positive).

If your PSA test is high, you may need more tests—like a prostate biopsy—to make sure that you don't have cancer. These tests can be harmful and cause a lot of worry.

False-negative results

PSA tests may miss some cancers. Not all prostate cancers cause a high PSA, so some PSA tests will be normal when there is cancer (called a false-negative). But the more serious prostate cancers usually do cause a high PSA and are more likely to be found with a PSA test.

Overdiagnosis

A PSA test can find cancers that would not have caused a problem (called overdiagnosis). You might have this type of cancer, but a PSA test can't tell if it's harmless. So you may get cancer treatment—including surgery or radiation—that you don't need.

What does the PSA test NOT tell you?

A PSA test alone can't tell if you have prostate cancer. This test only shows the level of your PSA. And a PSA test can't tell why your level is high. A biopsy is the only way to make sure that you don't have prostate cancer.

The PSA test also does not tell you if a cancer is growing fast or slow. Most prostate cancers that are found early are slow-growing. But a few prostate cancers grow fast.

What do numbers tell us about benefits and risks of PSA testing?

Examples of outcomes with and without PSA testing in men ages 55 to 69footnote 1*
Outcomes Without PSA testing With PSA testing
Prostate cancer deaths over a 13-year period About 6 out of 1,000 men About 5 out of 1,000 men
Prostate cancers found over a 13-year period About 68 out of 1,000 men About 102 out of 1,000 men
Risk of receiving treatment you don't need None As many as 400 out of 1,000 men
High PSA results that are not cancer (false-positives) None Out of 1,000 men who have a PSA test, about 170 of them will have a high PSA level. Out of these 170 men, about 53 of them will have cancer, while about 117 of them will not.

These numbers are from the largest, longest study done so far on the value of PSA testing. The study was done in Europe and did not include African-American men, who are at higher risk of prostate cancer.footnote 1 A smaller study done in the United States did not find that PSA testing saved lives.footnote 2

*Based on the best available evidence (evidence quality: moderate)

Benefits

The quality of the evidence about PSA benefits is moderate.

The largest study of prostate cancer screening so far showed that PSA testing may lower the risk of dying from prostate cancer in a small number of men.footnote 1

Take a group of 1,000 men ages 55 to 69 who have PSA testing over a 13-year period. footnote 1

  • About 5 out of 1,000 men who are screened will die from prostate cancer versus about 6 out of 1,000 men who are not screened.

Prostate cancer is more likely to be found with PSA testing than without.

Take a group of 1,000 men ages 55 to 69 who have PSA testing over a 13-year period. footnote 1

  • About 102 out of 1,000 men who are screened will be diagnosed with prostate cancer versus about 68 out of 1,000 men who are not screened.

Risks

The quality of the evidence about PSA risks is moderate.

PSA tests can show high levels of PSA that aren't caused by cancer (called a false-positive). This means you may need more tests—like a prostate biopsy—to make sure you don't have cancer. These tests can be harmful and cause a lot of worry.

Take a group of 1,000 men ages 55 to 69 who have a PSA test. footnote 1

  • About 170 of them will have a high PSA level. But most high PSA levels are not caused by cancer. Out of these 170 men with a high PSA level, about 117 of them will not have cancer, while about 53 of them will have cancer.

Many cancers found by PSA tests would not have caused a problem if they had not been found through screening. But when they are found, they often get treated with radiation or with surgery to remove the prostate. These cancer treatments may not have been needed. And they can have serious side effects, such as urinary, bowel, and erection problems.

Take a group of 1,000 men ages 55 to 69 who are diagnosed with prostate cancer.footnote 1

  • As many as 400 out of 1,000 men who are diagnosed with prostate cancer may get cancer treatment they don't need.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence.footnote 1 The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment will have a certain result and that 98 out of 100 will not, there's no way to know if you will be one of the 2 or one of the 98.

What do the experts recommend?

Experts disagree on how useful PSA testing is. PSA testing can help find prostate cancer early. But it may not help you live any longer than if you had no screening. And it could lead to harmful treatments you don't need. Talk with your doctor about your age, your health, your risk factors for prostate cancer, and the pros and cons of PSA testing. The choice is up to you.

Here's what some experts say:

  • The U.S. Preventive Services Task Force (USPSTF) recommends against PSA tests to look for prostate cancer. The USPSTF found that testing does more harm than good. Men who are tested may end up getting treatment they don't need, and those treatments can cause other problems. Few, if any, men are helped to live longer by having the test.
  • The American Cancer Society (ACS) advises men to talk with their doctors about testing and treatment before deciding about testing. The ACS says that men should not be tested without learning about the risks and benefits. The ACS advises talking to a doctor about testing:
    • At age 50 for men who are at average risk of getting prostate cancer and are expected to live at least 10 more years.
    • At age 45 for men at high risk, such as African Americans and men who have a first-degree relative (father, brother, or son) who had prostate cancer when he was younger than 65.
    • At age 40 for men at an even higher risk, such as those with several first-degree relatives who had prostate cancer at an early age.
  • The American Urological Association (AUA) recommends that:
    • Men under age 40 shouldn't have PSA screening.
    • Men ages 40 to 54 who are at average risk shouldn't have routine PSA screening.
    • Men ages 55 to 69 should talk with their doctors about having the test. Discuss the benefits and harms of PSA screening before deciding if you want the test. If you decide to have this test, having it every 2 years rather than every year may reduce the harms.
    • Men ages 70 and older (or any man with less than a 10- to 15-year life expectancy) shouldn't have routine PSA screening.

Why might your doctor offer PSA screening for you?

Your doctor may discuss PSA screening if you are in your 50s or 60s. If you're at high risk, your doctor may discuss screening sooner. If you don't already know your prostate cancer risk, you can ask your doctor.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have a PSA test Have a PSA test
  • You have a blood test to check your PSA level.
  • If your PSA is high, you'll need more tests. These may include repeat PSA tests or a prostate biopsy.
  • A PSA test can help find some prostate cancers early, when the cancer may be easier to treat.
  • PSA testing may lower the risk of dying from prostate cancer in a small number of men.
  • A PSA test may miss some cancers. Some PSA tests may be normal when there is cancer (called a false-negative).
  • A PSA test may show a high level that is not caused by cancer (called a false-positive). If your PSA test is high, you may need more tests—like a prostate biopsy—to make sure that you don't have cancer. These tests can be harmful and cause a lot of worry.
  • A PSA test may find cancers that would not have caused a problem (called overdiagnosis). This can lead to harmful cancer treatments that you don't need. These treatments can cause urinary, bowel, and erection problems.
Don't have a PSA test Don't have a PSA test
  • You have regular checkups that don't include a PSA test.
  • You could have a digital rectal exam rather than a PSA test. But keep in mind that this exam finds prostate cancer only when it is large enough to be felt. By that time, the cancer may be harder to treat.
  • You avoid testing that could lead to a diagnosis of cancer and treatments that can cause urinary, bowel, and erection problems.
  • You may miss the chance of finding prostate cancer early, when the cancer may be easier to treat.

Personal stories about having a prostate-specific antigen (PSA) test to screen for prostate cancer

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I have two children who are in high school right now, and both plan to go to college. It's important to me to provide for them and ensure that they have the money they need to finish their education. If I found out I had cancer, I would try any treatment that might offer me a chance to live longer, even if it has side effects. I'm going to have the PSA test.

Eric, age 56

For me, there is still too much uncertainty about how helpful the PSA test is and how accurate it is. I've read that high PSAs can be caused by things other than cancer. But the only way to know it's not cancer is to have a biopsy. I don't want to have to go through that if I don't have to. And the fact that I might be treated for a cancer that wouldn't have caused a problem is troublesome. So for now, I'm not going to have the PSA test.

Mike, age 62

My health is great. I still run, play tennis, and travel a lot. At my age, you start to see friends getting sick and dying of one thing or another, and it makes you start to think about your own health more. I know that the PSA test isn't perfect, but I want to have every chance I can to treat cancer early if I have it.

Jacob, age 68

I've done some reading on this subject, and I know that I'm a lot more likely to die from my heart disease than from prostate cancer. Right now I'm focusing my efforts on controlling my blood pressure and cholesterol because I know that treating those things can help me live longer and better. I know that if I had the PSA test and it was high, I would just worry and be stressed out.

Pieter, age 67

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a PSA test

Reasons not to have a PSA test

I want to find prostate cancer early.

I want to avoid the side effects of prostate cancer treatment.

More important
Equally important
More important

I want to be tested so I can have peace of mind.

I'm not worried that I might get prostate cancer.

More important
Equally important
More important

I want to know if I have prostate cancer.

I don't want to know if I have prostate cancer, because it may never affect my health.

More important
Equally important
More important

I think having a PSA test is worth the risk of having a false alarm if it could find prostate cancer early.

I want to avoid worry from a false alarm and more testing.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Have a PSA test

Do not have a PSA test

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Does a high PSA test result always mean you have prostate cancer?

  • Yes No, that's wrong. A high PSA level can have many causes, including an enlarged prostate, an infection, or, less often, prostate cancer. But most high PSA levels will not turn out to be cancer.
  • No You're right. A high PSA level can have many causes, including an enlarged prostate, an infection, or, less often, prostate cancer. But most high PSA levels will not turn out to be cancer.
  • I'm not sure It may help to go back and read "Get the Facts." A high PSA level can have many causes, including an enlarged prostate, an infection, or, less often, prostate cancer. But most high PSA levels will not turn out to be cancer.
2.

Can a PSA test find cancers that may never cause a problem?

  • Yes It's true. Many cancers found by PSA tests would not have caused a problem if they had not been found through screening. But when they are found, they often get treated with radiation or with surgery to remove the prostate.
  • No Sorry, that's wrong. Many cancers found by PSA tests would not have caused a problem if they had not been found through screening. But when they are found, they often get treated with radiation or with surgery to remove the prostate.
  • I'm not sure It may help to go back and read "Get the Facts." Many cancers found by PSA tests would not have caused a problem if they had not been found through screening. But when they are found, they often get treated with radiation or with surgery to remove the prostate.
3.

Is there a chance that a PSA test could save your life?

  • Yes You're right. PSA tests can help find some prostate cancers early, when the cancer may be easier to treat. The largest study of prostate cancer screening so far showed that PSA testing may lower the risk of dying from prostate cancer in a small number of men.
  • No No, that's wrong. PSA tests can help find some prostate cancers early, when the cancer may be easier to treat. The largest study of prostate cancer screening so far showed that PSA testing may lower the risk of dying from prostate cancer in a small number of men.
  • I'm not sure It may help to go back and read "Get the Facts." PSA tests can help find some prostate cancers early, when the cancer may be easier to treat. The largest study of prostate cancer screening so far showed that PSA testing may lower the risk of dying from prostate cancer in a small number of men.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits

Credits
Author Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Christopher G. Wood, MD, FACS - Urology, Oncology
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Prostate Cancer Screening: Should I Have a PSA Test?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Have a PSA test to check for prostate cancer.
  • Do not have a PSA test to check for prostate cancer.

This decision aid is for men in their 50s and 60s who are thinking about having a PSA test to screen for prostate cancer. It is not for men who have been diagnosed with prostate cancer or are at high risk. If you don't already know your prostate cancer risk, you can ask your doctor.

Key points to remember

  • PSA tests can help find some prostate cancers early, when the cancer may be easier to treat. The largest study of prostate cancer screening so far showed that PSA testing may lower the risk of dying from prostate cancer in a small number of men.
  • A high PSA level can have many causes, including an enlarged prostate, an infection, or, less often, prostate cancer. A high PSA can cause a lot of worry and lead to more tests. But most high PSA tests will not turn out to be cancer.
  • Many cancers found by PSA tests would not have caused a problem if they had not been found through screening. But when they are found, they often get treated with radiation or with surgery to remove the prostate. These cancer treatments may not have been needed. And they can have serious side effects, such as urinary, bowel, and erection problems.
  • PSA testing increases the chance that you will be diagnosed with prostate cancer. This is because screening finds cancers that otherwise would never have been found. The chance of being diagnosed with cancer increases each time you have the test.
  • Many prostate cancers grow slowly. This means that many men with prostate cancer will die of something else before their prostate cancer advances enough to cause any problems.
  • With faster-growing prostate cancers, finding the cancer early may not help you live longer. Some prostate cancers will be fatal no matter when they are found.
FAQs

What is prostate cancer?

Prostate cancer is the abnormal growth of cells in the tissues of the prostate gland . It is the second most common cancer in men. Most men who get it are older than 65.

Early prostate cancer usually doesn't cause symptoms. When prostate cancer is found early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate. Or if the cancer is considered low-risk, active surveillance or watchful waiting is an option. As prostate cancer grows or spreads, symptoms may develop, including urinary problems (such as blood in the urine) and bone pain.

Many prostate cancers grow slowly. This means that many men with prostate cancer will die of something else before their prostate cancer advances enough to cause any problems. With faster-growing prostate cancers, finding the cancer early may not help you live longer. Some prostate cancers will be fatal no matter when they're found.

What is a PSA test?

The prostate-specific antigen (PSA) test is a blood test that measures your level of PSA. The PSA test is usually done to screen for prostate cancer in men who have no symptoms.

PSA is released into a man's blood by the cells of his prostate gland. A PSA test can show if you have normal or high amounts of PSA in your blood. A high PSA level can have many causes, including an enlarged prostate, an infection, or, less often, prostate cancer.

What are the benefits of having a PSA test?

PSA tests can help find some prostate cancers early, when the cancer may be easier to treat. The largest study of prostate cancer screening so far showed that PSA testing may lower the risk of dying from prostate cancer in a small number of men.

But experts disagree on how useful PSA testing is. For many men, it may not help them live any longer than if they'd had no screening.

What are the risks of having a PSA test?

False-positive results

Often the PSA test can show high levels of PSA that aren't caused by cancer (called a false-positive).

If your PSA test is high, you may need more tests—like a prostate biopsy—to make sure that you don't have cancer. These tests can be harmful and cause a lot of worry.

False-negative results

PSA tests may miss some cancers. Not all prostate cancers cause a high PSA, so some PSA tests will be normal when there is cancer (called a false-negative). But the more serious prostate cancers usually do cause a high PSA and are more likely to be found with a PSA test.

Overdiagnosis

A PSA test can find cancers that would not have caused a problem (called overdiagnosis). You might have this type of cancer, but a PSA test can't tell if it's harmless. So you may get cancer treatment—including surgery or radiation—that you don't need.

What does the PSA test NOT tell you?

A PSA test alone can't tell if you have prostate cancer. This test only shows the level of your PSA. And a PSA test can't tell why your level is high. A biopsy is the only way to make sure that you don't have prostate cancer.

The PSA test also does not tell you if a cancer is growing fast or slow. Most prostate cancers that are found early are slow-growing. But a few prostate cancers grow fast.

What do numbers tell us about benefits and risks of PSA testing?

Examples of outcomes with and without PSA testing in men ages 55 to 691*
Outcomes Without PSA testing With PSA testing
Prostate cancer deaths over a 13-year period About 6 out of 1,000 men About 5 out of 1,000 men
Prostate cancers found over a 13-year period About 68 out of 1,000 men About 102 out of 1,000 men
Risk of receiving treatment you don't need None As many as 400 out of 1,000 men
High PSA results that are not cancer (false-positives) None Out of 1,000 men who have a PSA test, about 170 of them will have a high PSA level. Out of these 170 men, about 53 of them will have cancer, while about 117 of them will not.

These numbers are from the largest, longest study done so far on the value of PSA testing. The study was done in Europe and did not include African-American men, who are at higher risk of prostate cancer.1 A smaller study done in the United States did not find that PSA testing saved lives.2

*Based on the best available evidence (evidence quality: moderate)

Benefits

The quality of the evidence about PSA benefits is moderate.

The largest study of prostate cancer screening so far showed that PSA testing may lower the risk of dying from prostate cancer in a small number of men.1

Take a group of 1,000 men ages 55 to 69 who have PSA testing over a 13-year period. 1

  • About 5 out of 1,000 men who are screened will die from prostate cancer versus about 6 out of 1,000 men who are not screened.

Prostate cancer is more likely to be found with PSA testing than without.

Take a group of 1,000 men ages 55 to 69 who have PSA testing over a 13-year period. 1

  • About 102 out of 1,000 men who are screened will be diagnosed with prostate cancer versus about 68 out of 1,000 men who are not screened.

Risks

The quality of the evidence about PSA risks is moderate.

PSA tests can show high levels of PSA that aren't caused by cancer (called a false-positive). This means you may need more tests—like a prostate biopsy—to make sure you don't have cancer. These tests can be harmful and cause a lot of worry.

Take a group of 1,000 men ages 55 to 69 who have a PSA test. 1

  • About 170 of them will have a high PSA level. But most high PSA levels are not caused by cancer. Out of these 170 men with a high PSA level, about 117 of them will not have cancer, while about 53 of them will have cancer.

Many cancers found by PSA tests would not have caused a problem if they had not been found through screening. But when they are found, they often get treated with radiation or with surgery to remove the prostate. These cancer treatments may not have been needed. And they can have serious side effects, such as urinary, bowel, and erection problems.

Take a group of 1,000 men ages 55 to 69 who are diagnosed with prostate cancer.1

  • As many as 400 out of 1,000 men who are diagnosed with prostate cancer may get cancer treatment they don't need.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence.1 The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment will have a certain result and that 98 out of 100 will not, there's no way to know if you will be one of the 2 or one of the 98.

What do the experts recommend?

Experts disagree on how useful PSA testing is. PSA testing can help find prostate cancer early. But it may not help you live any longer than if you had no screening. And it could lead to harmful treatments you don't need. Talk with your doctor about your age, your health, your risk factors for prostate cancer, and the pros and cons of PSA testing. The choice is up to you.

Here's what some experts say:

  • The U.S. Preventive Services Task Force (USPSTF) recommends against PSA tests to look for prostate cancer. The USPSTF found that testing does more harm than good. Men who are tested may end up getting treatment they don't need, and those treatments can cause other problems. Few, if any, men are helped to live longer by having the test.
  • The American Cancer Society (ACS) advises men to talk with their doctors about testing and treatment before deciding about testing. The ACS says that men should not be tested without learning about the risks and benefits. The ACS advises talking to a doctor about testing:
    • At age 50 for men who are at average risk of getting prostate cancer and are expected to live at least 10 more years.
    • At age 45 for men at high risk, such as African Americans and men who have a first-degree relative (father, brother, or son) who had prostate cancer when he was younger than 65.
    • At age 40 for men at an even higher risk, such as those with several first-degree relatives who had prostate cancer at an early age.
  • The American Urological Association (AUA) recommends that:
    • Men under age 40 shouldn't have PSA screening.
    • Men ages 40 to 54 who are at average risk shouldn't have routine PSA screening.
    • Men ages 55 to 69 should talk with their doctors about having the test. Discuss the benefits and harms of PSA screening before deciding if you want the test. If you decide to have this test, having it every 2 years rather than every year may reduce the harms.
    • Men ages 70 and older (or any man with less than a 10- to 15-year life expectancy) shouldn't have routine PSA screening.

Why might your doctor offer PSA screening for you?

Your doctor may discuss PSA screening if you are in your 50s or 60s. If you're at high risk, your doctor may discuss screening sooner. If you don't already know your prostate cancer risk, you can ask your doctor.

2. Compare your options

  Have a PSA test Don't have a PSA test
What is usually involved?
  • You have a blood test to check your PSA level.
  • If your PSA is high, you'll need more tests. These may include repeat PSA tests or a prostate biopsy.
  • You have regular checkups that don't include a PSA test.
  • You could have a digital rectal exam rather than a PSA test. But keep in mind that this exam finds prostate cancer only when it is large enough to be felt. By that time, the cancer may be harder to treat.
What are the benefits?
  • A PSA test can help find some prostate cancers early, when the cancer may be easier to treat.
  • PSA testing may lower the risk of dying from prostate cancer in a small number of men.
  • You avoid testing that could lead to a diagnosis of cancer and treatments that can cause urinary, bowel, and erection problems.
What are the risks and side effects?
  • A PSA test may miss some cancers. Some PSA tests may be normal when there is cancer (called a false-negative).
  • A PSA test may show a high level that is not caused by cancer (called a false-positive). If your PSA test is high, you may need more tests—like a prostate biopsy—to make sure that you don't have cancer. These tests can be harmful and cause a lot of worry.
  • A PSA test may find cancers that would not have caused a problem (called overdiagnosis). This can lead to harmful cancer treatments that you don't need. These treatments can cause urinary, bowel, and erection problems.
  • You may miss the chance of finding prostate cancer early, when the cancer may be easier to treat.

Personal stories

Personal stories about having a prostate-specific antigen (PSA) test to screen for prostate cancer

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I have two children who are in high school right now, and both plan to go to college. It's important to me to provide for them and ensure that they have the money they need to finish their education. If I found out I had cancer, I would try any treatment that might offer me a chance to live longer, even if it has side effects. I'm going to have the PSA test."

— Eric, age 56

"For me, there is still too much uncertainty about how helpful the PSA test is and how accurate it is. I've read that high PSAs can be caused by things other than cancer. But the only way to know it's not cancer is to have a biopsy. I don't want to have to go through that if I don't have to. And the fact that I might be treated for a cancer that wouldn't have caused a problem is troublesome. So for now, I'm not going to have the PSA test."

— Mike, age 62

"My health is great. I still run, play tennis, and travel a lot. At my age, you start to see friends getting sick and dying of one thing or another, and it makes you start to think about your own health more. I know that the PSA test isn't perfect, but I want to have every chance I can to treat cancer early if I have it."

— Jacob, age 68

"I've done some reading on this subject, and I know that I'm a lot more likely to die from my heart disease than from prostate cancer. Right now I'm focusing my efforts on controlling my blood pressure and cholesterol because I know that treating those things can help me live longer and better. I know that if I had the PSA test and it was high, I would just worry and be stressed out."

— Pieter, age 67

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a PSA test

Reasons not to have a PSA test

I want to find prostate cancer early.

I want to avoid the side effects of prostate cancer treatment.

             
More important
Equally important
More important

I want to be tested so I can have peace of mind.

I'm not worried that I might get prostate cancer.

             
More important
Equally important
More important

I want to know if I have prostate cancer.

I don't want to know if I have prostate cancer, because it may never affect my health.

             
More important
Equally important
More important

I think having a PSA test is worth the risk of having a false alarm if it could find prostate cancer early.

I want to avoid worry from a false alarm and more testing.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Have a PSA test

Do not have a PSA test

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Does a high PSA test result always mean you have prostate cancer?

  • Yes
  • No
  • I'm not sure
You're right. A high PSA level can have many causes, including an enlarged prostate, an infection, or, less often, prostate cancer. But most high PSA levels will not turn out to be cancer.

2. Can a PSA test find cancers that may never cause a problem?

  • Yes
  • No
  • I'm not sure
It's true. Many cancers found by PSA tests would not have caused a problem if they had not been found through screening. But when they are found, they often get treated with radiation or with surgery to remove the prostate.

3. Is there a chance that a PSA test could save your life?

  • Yes
  • No
  • I'm not sure
You're right. PSA tests can help find some prostate cancers early, when the cancer may be easier to treat. The largest study of prostate cancer screening so far showed that PSA testing may lower the risk of dying from prostate cancer in a small number of men.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.
 
Credits
By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Christopher G. Wood, MD, FACS - Urology, Oncology

References
Citations
  1. Schröder FH, et al. (2014). Screening and prostate-cancer mortality: Results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet, 384(9959): 2027–2035. DOI: 10.1016/S0140-6736(14)60525-0. Accessed May 5, 2015.
  2. Andriole GL, et al. (2012). Prostate cancer screening in the randomized prostate, lung, colorectal, and ovarian cancer screening trial: Mortality results after 13 years of follow-up. Journal of the National Cancer Institute, 104(2): 125–132. DOI: 10.1093/jnci/djr500. Accessed May 8, 2015.

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