HEALTH

Prostate cancer screening: Should men get tested? And when? Here's what to know

Bryant Stamford
Special to the Courier Journal
  • PSA levels can be elevated for reasons other than cancer, such as an enlarged or inflamed prostate.
  • False positive and false negative PSA test results are possible.
  • The American Cancer Society does not recommend routine PSA screening for all men, particularly young men.
  • Regular PSA testing is generally considered prudent for middle-aged men (starting at age 45).

PSA stands for prostate-specific antigen, a substance naturally produced in prostate tissue. A small amount of PSA regularly sneaks into the bloodstream, and low blood concentration is considered normal. However, when levels are high, especially if there is a sudden increase in concentration, it raises a red flag.

This is because cancer cells usually make more PSA than normal cells, and this is why the PSA test has been used to screen for cancer. While this seems logical, PSA levels can be elevated for reasons other than cancer.

An enlarged prostate gland, known as BPH for benign prostatic hyperplasia, is very common in men over the age of 50, and it can produce more PSA. The same is true for an inflamed prostate, and there may be other causes. This means “false positive” tests (a high PSA suggests cancer exists when it doesn’t) are not uncommon.

On the other hand, some prostate cancers don’t produce much PSA. This would result in a “false negative” test (cancer exists, but the test misses it).

OK, so there are false positive and false negative results. Perhaps more important is what many physicians do with the results.

To be sure, early detection of cancer and quick action are best. But what if quick action (in response to false positive test results) leads to very painful and expensive prostate biopsies? Or worse, what if there is a quick decision to move ahead with unnecessary surgery?

I have my own story to tell that relates to this quick action issue.

Could a high PSA test result mean cancer?

Public health organizations such as the Centers for Disease Control and Prevention recommend that men get regular PSA screenings for prostate health starting at age 50, or by age 40 if they have a family history or are African American.

Several years ago, I had my annual physical exam and all seemed well. When I asked my doctor about my PSA results, we learned that the test had not been done. The doctor, trying to be helpful, told me the lab probably still had my blood sample, and he would call and order the test. Fine with me, and I was on my way.

Later that day I got a call from my doctor. My PSA results were alarmingly high, and worse was the dramatic leap from 1.4 to over 9.0 (way beyond an acceptable upper limit of 4.0 for men my age). I was told that an appointment with a urologist had been arranged for me first thing the next morning.

The urologist explained that PSA scores as high as mine are very rare, and so was the incredible change from my results a year ago. We had no time to waste, and biopsies were needed. I was stunned and tried to argue that none of it made sense since I followed every health rule and hadn’t veered off course since my last test. What’s more, I had no prostate hypertrophy. He shook his head and told me that my lifestyle was irrelevant, and my normal size prostate gland made things even worse. Huh?

He further explained that prostate cancer is contained within the capsule surrounding the prostate gland for quite some time before it escapes. This would enlarge the prostate. However, in my case, the normal size of my prostate combined with sky high PSA results suggested that the cancer had escaped early, causing a faster spread. His tone was grim, and the message was clear.

Cancer had very likely already spread throughout my entire body.

I was given a prescription for an antibiotic and scheduled to return for a series of biopsies a few days later. When I left the office, the thought struck me that my blood sample had been taken more than a week earlier. Could that impact my PSA results? I called a friend who works as a lab tech and asked her. She laughed and told me that results from that week-old blood sample would be about as accurate as multiplying my eye color times my shoe size!

I called my doctor and told him why I wanted another blood test immediately. We did the test, and my PSA results were back down to their typical very low level. When I called the urologist to cancel the biopsies, he was upset with me.

“OK, so you have one high score and one low score. You, of course, choose to believe the low score because you are in denial. That’s a normal response, but if the high score is correct, we are wasting valuable time ... time that could save your life," the urologist said.

I told him I intended to have a third test, and more if necessary, just to be sure. I did, and all results were low.

Should I get a prostate-specific antigen test?

Prostate cancer awareness ribbon and stethoscope on blue background. Horizontal composition.

The American Cancer Society does not recommend “routine” PSA screening for men of all ages, especially not young men.

However, there may be exceptions in some younger men, and if so “pre-test screening” is advised. This involves frank and open pro-and-con discussions between doctor and patient in which many issues are taken into consideration, including age, race (African-American men are at higher risk), family history, diet and obesity (a high fat diet and too much body fat increase risk).

In general, experts agree that for middle-age men (starting at age 45) regular PSA testing is prudent. For men 70 and over, PSA screening may not be recommended because prostate cancer is slow growing and lifespan is limited, plus intervention so late in life may do more harm than good. However, many experts believe testing so late in life still has value.

In a nutshell, every step should be taken to catch prostate cancer as early as possible, and this can include PSA testing. But we need to be aware of limitations associated with testing, especially in younger men, and be on guard to avoid rushing to judgement.

Reach Bryant Stamford, Emeritus Professor of Kinesiology & Integrative Physiology at Hanover College, at stamford@hanover.edu.