PSA (prostate-specific antigen) is a blood test that can become elevated in prostate cancer. Unfortunately, it has led to overdiagnosis — it is often positive in cases of very early prostate cancer, which, if left untreated, may never cause problems. On the flip side, PSA testing can detect prostate cancer at an early, curable stage — cancer that could be fatal if detected later. The five-year survival rate for early-stage (Stage 1) prostate cancer is nearly 100%, while for late-stage (Stage 4), it drops to around 30%.
Despite this, routine PSA testing was discouraged in 2010, leading to a decline in regular screenings.
As routine testing decreased, the overall number of prostate cancer diagnoses went down — but prostate cancer deaths increased. In other words, fewer harmless early cancers were being detected, but more treatable cancers were missed and allowed to progress.
To shed more light on this issue, a recent European study involving 163,000 men who were routinely screened over 16 years showed a 48% decrease in prostate cancer deaths.
Armed with this new data, evolving guidelines now recommend:
- Limit PSA screening to every 2–4 years for men over age 50 who have a life expectancy of 10 years or more.
- Begin screening at age 45 for men with a family history of prostate cancer or those of African descent.
- Begin screening at age 40 for men with a positive BRCA2 mutation (which may be present if you have a family history of breast cancer — male or female).
Dr. Charlie Barnett is a contributor at KnoxTNToday for a weekly column, DocTalk, providing his expertise on health and wellness management.
