Should you get a PSA screening?

Sanford doctor spells out prostate cancer test pros and cons

Should you get a PSA screening?

The goal of any cancer screening is to find the disease before it has the chance to spread. Once discovered early, cancer is often easier to treat and with fewer side effects.

Testing for elevated prostate-specific antigen levels (PSA) in the blood can help detect prostate cancer. This early discovery, as with other cancers, can sometimes lead to better outcomes.

It could be assumed then that prostate cancer screening would be encouraged as a preventive measure for all men of a certain age, as is the case with screenings for colon and lung cancer.

The reality is that the potential harm of unnecessary treatment can sometimes outweigh the possible benefits.

There is an overwhelming medical consensus on one point: You should seek a conversation with your doctor when considering this screening.

Khalin Dendy, M.D., is a specialist in internal medicine at Sanford Fifth & Broadway Clinic in Bismarck, North Dakota. He often explains the pros and cons of PSA testing to his patients.

False positives for this blood test are common, he will tell them. And even if the results are accurate, not all prostate cancers warrant treatment.

We asked Dr. Dendy to explain concerns surrounding prostate cancer and issues to consider when contemplating a screen for PSA.

What factors increase the risk of prostate cancer?

These are some known risk factors for developing prostate cancer:

  • Age: The most common risk factor. The older you are, the more likely you are to develop prostate cancer.
  • Race: Black men are more likely to get prostate cancer, get it at a younger age, have advanced disease before it is diagnosed, and are twice as likely to die from prostate cancer.
  • Weight: Being overweight can increase your risk.
  • Genetics: Having a close family member – father, son or brother – who’s been diagnosed with prostate cancer raises your risk.

What is a PSA test?

The test for prostate specific antigen looks at a blood sample for this specific antigen that is made in the prostate. The challenge with this screening is that normal prostate tissue makes PSA and a certain amount of that leaks into the bloodstream. Cancer cells seem to make PSA at a higher rate but not always.

If the PSA is elevated, sometimes that can be an indication that there could be cancer, but it doesn’t mean that there is cancer. And sometimes even when the PSA is normal, there could still be cancer.

There are other conditions that can cause PSA to be elevated beyond cancer. Things like prostate infection or a urine infection or trauma to the prostate can make that number go up.

What are the differences between risk factors and warning signs of prostate cancer?

Risk factors can increase a man’s chance of getting prostate cancer but are not actually symptoms in themselves.

The warning signs of prostate cancer would be actual symptoms but are sometimes nonexistent. Prostate cancer is often asymptomatic, which is one of this disease’s challenges.

Signs and symptoms associated with prostate cancer:

  • Trouble urinating or decreased force of urination
  • A need to urinate frequently especially at night
  • Blood in urine or semen
  • Pain or burning during urination
  • Bone pain in the back, hips or pelvis
  • Erectile dysfunction
  • Painful ejaculation
  • Unexplained weight loss

“All of those symptoms can be caused by other things as well, however. For example, urination changes in men are more often due to benign enlargement of the prostate than because of prostate cancer,” Dr. Dendy said.

The most important thing to remember regarding prostate cancer screening is having a conversation with your primary care provider about your personal risks and health care preferences.

When you are talking to a patient about a PSA test, what do you tell them?

“One of the first things I’ll tell my patients is that many men will develop prostate cancer in their life, but most men will not die from prostate cancer,” Dr. Dendy said. “Most men will never have a symptom of prostate cancer. The reason for that is that most prostate cancers are extremely slow growing. They are slow growing to the point that a man is more likely to die of some other cause before prostate cancer would ever impact them.”

There are clinical decision tools available for providers to use in advising patients. This information gets into statistics in terms of how many men have to be screened to prevent one death from prostate cancer. It can help guide your conversations.

Overdiagnosis is often a risk because most prostate cancers are slow growing.

“We may find a prostate cancer through screening that would never hurt a man in their life. And yet the only way for us to find that prostate cancer through screening is to start with a PSA and then likely go on to other tests like a prostate biopsy – something that does have some risk of harm,” Dr. Dendy said.

Prostate biopsies can cause bleeding. They can cause infection. They can cause pain. They can also sometimes cause nerve damage or sexual dysfunction.

For Dr. Dendy, the No. 1 factor to consider when talking to patients are their specific risks. He encourages you to look at the potential harms and potential benefits, then make a mutual decision with your provider on whether it’s the right thing to get screened for prostate cancer yourself.

“Typically, we recommend these conversations start around age 50, but if they have one of the risk factors, we may want to start that discussion at 40 to 45 years old,” Dr. Dendy said. “When a patient reaches the age of 70, generally if they haven’t developed clinically significant prostate cancer by that time, they’re unlikely to develop it in their lifetime. I would be hesitant to recommend prostate screening for someone over the age of 70.”

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Posted In Cancer, Cancer Screenings, Healthy Living