Northwest Health | WINTER 2009 By KJ Fields

MEN'S HEALTH

PSA Test Raises Complex Questions

Decisions around prostate cancer screenings are unique to each man

Some medical screening tests are widely recommended by doctors, such as mammograms to help detect breast cancer. But for men thinking about the prostate-specific-antigen (PSA) test for prostate cancer screening, it's not so simple. While the test may identify prostate cancer risk, it can raise as many questions as it answers.

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Jeff Brodie, MD, family physician at Group Health Poulsbo Medical Center, says it's important for men to talk to their doctors to understand what having the test really means, and whether it's right for them. "People believe that this blood test tells you whether you have prostate cancer or not, but it doesn't give you a yes or no answer, and it can lead to a cascade of challenging decisions."

A high PSA count may or may not mean you have cancer. The male prostate gland, which makes the fluid that nourishes and protects sperm, swells as men age. A high PSA level of 4 nanograms per milliliter (ng/mL) or more in the bloodstream may indicate the potential for cancer. But several noncancerous factors, including an enlarged prostate due to age, may also increase PSA levels.

Among men with a high PSA, about 25 percent actually have prostate cancer. If the cancer is aggressive, the test may alert the physician and patient in time to treat the disease before it becomes life-threatening. On the other hand, most prostate cancer is slow growing. Older men who have it often die from unrelated causes.

Even a low PSA value can be misleading. While it usually suggests a minimal risk for cancer, studies show that's not always true. A digital rectal exam is often performed along with the PSA test, but a biopsy of the prostate gland is the only sure way to determine if cancer is present.

Research indicates that most men will get prostate cancer if they live long enough. In addition to age, risk is known to be higher for African-American men, people with a family history of the disease, and those eating a diet high in saturated fats.

Side effects of treatment may impact decision. Even if prostate cancer is diagnosed, a patient's individual circumstances can greatly influence the choice of treatment or active monitoring. Radiation, surgery, and other treatment options don't always significantly improve survival rates. And all the choices can cause serious side effects — such as impotence and urinary incontinence.

"Treatment usually leads to only a modest improvement in survival rates," says Dr. Brodie. "Without treatment, many men will still be alive in 10 years."