Should I get prostate cancer screening (PSA test)?
as discussed by Dr XP Cheah consulting GP at the Madison Medical Practice St Ives
Prostate cancer is the most common cancer in men in Australia. In 2022, over 24 000 men were diagnosed with the disease, with over 3500 dying from it.
Screening for prostate cancer involves a blood test measuring a protein called prostate specific antigen (PSA). PSA is only made in the prostate and is normally found in low levels in the blood. High levels of PSA can be due to many reasons, including infection or inflammation of the prostate, benign growth of the prostate (which commonly occurs as men get older), and least commonly, prostate cancer.
This means a high PSA does not necessarily mean prostate cancer (a false positive). Likewise, a normal PSA does not guarantee that prostate cancer is not present (a false negative).
Prostate cancer in its early stages usually does not result in any symptoms and might only produce symptoms like reduced urine flow or painful urination once the cancer grows large enough. As such, one benefit of PSA testing is detecting prostate cancer in its early stages when it is still treatable.
Disadvantages of PSA testing include stress and anxiety from falsely elevated results (i.e., from a benign cause). Further testing, like a biopsy, can also have side effects like erectile dysfunction and urinary incontinence. If prostate cancer is diagnosed, the treatment itself can also produce unpleasant side effects, which can affect your quality of life, for a cancer that might not necessarily have caused problems if left alone.
If PSA testing reveals abnormal results, your doctor will discuss with you the next steps. This may include investigating and managing other treatable causes like a urinary tract infection, then repeating the PSA test. Your doctor might refer you to a urologist, who might decide to order an MRI. An MRI can help a urologist decide about proceeding with a prostate biopsy, or if monitoring is appropriate.
If prostate cancer is diagnosed, treatment options include surgery, radiation therapy and hormone therapy. There is also the possibility of active surveillance (monitoring with PSA tests, MRI, biopsies at regular intervals, for cancers that are small and slow growing and unlikely to spread) as well as watchful waiting (regular PSA testing and check ups, usually for older men where the cancer is not likely to cause any issues in their lifetime).
Men in the 50 to 70 age group with a life expectancy of at least 10 years are most likely to benefit from PSA testing. A decision to undergo PSA testing is a personal one, with your doctor helping you make an informed decision after weighing up the risks and benefits.
References:
1. https://www1.racgp.org.au/ajgp/2023/march/prostate-specific-antigen-psa-testing-for-prostate
2. Australian Institute of Health and Welfare, Australian Government. Cancer data in Australia. Darlinghurst, NSW: Australian Institute and Health Welfare, 2022. www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/cancer-rankings-data-visualisation
3. https://www.cancer.org.au/cancer-information/types-of-cancer/prostate-cancer
4. https://healthymale.org.au/files/resources/psa_test_fact_sheet_healthy_male_2019.pdf