Five years ago, the U.S. Preventive Services Task Force recommended against routine blood tests to measure your level of prostate-specific antigens – the PSA test. The task force now recommends men 55 to 69 should talk with their doctor about whether to have the test.
Dr. Muhammad Nasir is Senior Lead Physician with the Bluitt-Flowers Health Center at Parkland Hospital.
Why PSA screening is an issue: “The PSA itself is not a very reliable test. It could be positive and patients may have prostate cancer even in the “normal” PSA levels as well as it could be falsely elevated with other diseases like inflammation of the prostate gland, enlarged prostate, urinary retention. So it’s caused a lot of anxiety to the patients as well as expense of unnecessary tests.”
Why the PSA test is still used? “It has a significance in early detection, but the key is that you go with other risk factors also: Patients who have strong family history of prostate cancer or patients who have other symptoms of prostate problems. It can be detected early.”
Why the 55 to 69 age range is important: “This is the most common age where patients have prostate cancer. It is a cancer of the old men. Average age is about 65 to 66. We hardly ever find any prostate cancer below age 4o unless there’s a very strong family history.”
Why not 70 or older? “It’s a slow growing tumor and if you have some other co-morbidities, and the life expectancy is low, there is no reason to do the screening test and create anxiety for the patient and do more tests that may not have any outcome.”
Why there’s still debate about how to detect prostate cancer: “This is the only test that is available right now, and the problem is that the PSA (prostate-specific antigen) is secreted by the prostate gland as well as by cancer cells. So, there is no special test available where you could differentiate whether this PSA is released by a normal prostate gland or by cancer cells. They are still doing some studies to have a specialized test.”
What about the digital rectal exam? “For diagnosis of prostate cancer, it’s a combination of doing a blood test as well as doing a digital rectal exam. They are also recommending not to do the PSA levels right after the digital rectal exam because it can falsely elevate the PSA levels. So it’s recommended you do it either before the digital rectal exam or maybe after four to six weeks to make sure the PSA that you’re testing is reliable.”
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