Guest post featuring Ronald D. Ennis, MD, Director Radiation Oncology at Mount Sinai St. Luke’s and Mount Sinai Roosevelt
Yes. The PSA or prostate-specific antigen blood test, although not perfect, is the most effective way to detect prostate cancer. It is the only available screening test for prostate cancer, and thus, is the only indicator to determine if a biopsy should be done. “We save people from dying of prostate cancer thanks to the PSA test, and there is no other way to do that right now,” explains Dr. Ronald D. Ennis. PSA is a protein made in the prostate gland. A PSA level that increases over time can indicate the presence of cancer.
Q. Who should get a PSA test?
A. “Prostate cancer is considered a silent disease, remaining largely asymptomatic until its final stages, so it’s important that men over age 50 are screened regularly,” Dr. Ennis says. Men who have a family history of prostate cancer or who are African American are at higher risk, and should start screening between the ages of 40 and 45. You can be tested by your primary care physician at an annual wellness exam, or by a urologist.
Q. What is a normal PSA level, and what is considered high?
A. Traditionally, a PSA of more than 4 mg/mL is considered high. It is possible for a man to have a high PSA level and not to have cancer. Unfortunately, the opposite also is true. A man can have a low PSA and actually have cancer. According to Dr. Ennis, that’s why an annual screening test is so important for establishing a baseline of data that can be monitored and compared with subsequent tests. “After one abnormal test result, before doing anything else, patients should usually just repeat the test to ensure it was an accurate reading, as PSA levels can fluctuate,” he adds.
Q. What if my PSA level is rising?
A. If a series of PSA tests show that your levels are increasing, your urologist may decide to take a biopsy of the prostate. While the PSA test is used to suspect prostate cancer, biopsies are the only way to diagnose the disease. “In many patients, prostate cancer is slow-growing and not immediately life-threatening, but that is not always the case,” Dr. Ennis says. “The PSA test can help alert us to the slow-growing and the more lethal types of prostate cancer, both of which can only be identified under a microscope after a biopsy.”
Q. Isn’t the PSA test a controversial cancer screening?
A. In recent years, there has been quite a bit of controversy about whether PSA screening should be done, since the results can prompt unnecessary biopsies and treatment. “It’s true that some men will not benefit from screening and some might go through testing and treatment when they do not need it, but the test is still the only way to find the more aggressive kind of prostate cancer,” Dr. Ennis says. “In fact, in the European study on prostate cancer screening, the prostate cancer death rate declined by 20 percent because of the PSA test, so the screening does save lives.”
Dr. Ennis believes regular, widespread screenings should continue, but that doctors should be more selective about biopsies. “If we refine the way we screen, biopsy less aggressively, and do more ‘watchful waiting’ surveillance of the less-aggressive types of prostate cancer, we can remove some of the downside of the screening,” he says.