Why is there so much confusion around PSA screening? Shouldn’t I be screened?

Expert Opinion published on January 13, 2012 in Diagnosis & Screening
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Dan Zenka, APR
Senior Vice President, Communications
The Prostate Cancer Foundation
Prostate Cancer Patient and Advocate
Why is there so much confusion around PSA screening? Shouldn’t I be screened?

Yes, there is a lot of confusion around PSA screening, which is screening for prostate-specific antigen in the patient’s blood. What patients need to understand is that PSA screening, or the PSA test, is not a cancer test. It is more of a smoke alarm for the prostate. It can indicate several things that might be going wrong in a man’s prostate. It could be an infection that can be taken care of and treated with antibiotics. It could be simple enlargement of the prostate which occurs in many men as they age up. It could also be an indicator that there might be the presence of cancer growing in the prostate. So it is the first tool or the first step of a diagnostic process for cancer, number one. Secondly, if after analyzing prostate scores, or PSA score if you will, let us say year over year and you see a rise, it will depend upon the PSA numbers. Generally the threshold for a physician to recommend a biopsy is a PSA score of 4.

Now I will use myself as an example here, having had annual PSA tests since I was 40 and a DRE with my annual exam, my PSA went from 3.1 to 5.8 in a years’ time. That is nearly doubling, that is an acceleration of PSA that signals, “Hmm, something might be going on here beyond just enlargement.” So in consultation I made an informed decision with my urologist to undergo a biopsy, and then those scores came back and they indicated yes, indeed, I did have cancer. The Gleason scores, which is something that patients have to understand, mine were 7, made of 4 + 3s which is more aggressive than 3 + 4s. It was in 50% of my prostate in terms of involvement. So, looking at those numbers, we then, once again, made an informed decision based upon the facts and the data that we had, that I would proceed to having a radical prostatectomy.

So a PSA is not an end-all, it is one step in a diagnostic process for cancer and it is, to date, the best tool we have, and patients need to understand that more fully.  

Last modified: February 7, 2012
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