PSA
What is the PSA?
PSA is an abbreviation for Prostate Specific Antigen. The PSA is a protein that is produced
almost exclusively by the prostate gland. In normal circumstances, only a small amount of the
PSA leaks out of the prostate and into the bloodstream. However, in certain conditions (like
cancer of the prostate), more PSA leaks into the blood.
Why should I get the PSA test?
In some people with prostate cancer, the blood level of the PSA will be higher than normal.
When prostate cancer is detected by using the PSA, the cancer is usually detected at an earlier
stage where there is potentially a better chance for a cure. Both the American Cancer Society
(ACS) and the American Urological Society recommend that all men over the age of 50 have a
discussion with their health care provider about the risks and benefits of an annual rectal
examination and a PSA. If you are at high risk for prostate cancer (that is, African-American, or
a man with one first degree relative with diagnosis of prostate cancer prior to age 65), the ACS
recommends having this discussion with your provider starting at age 45. If you are at
HIGHEST risk (two or more first degree relatives with diagnosis of prostate cancer before 65),
then the ACS recommends having this discussion with your provider starting at age 40.
What are some reasons NOT to get a PSA?
Besides cancer of the prostate, a number of other much less serious processes can cause the PSA
level to be elevated. These processes include benign enlargement of the prostate (more common
as you get older), prostatitis (infection of prostate gland) and urinary retention. For this reason,
once an elevated PSA level is found, additional tests need to be done to decide if the elevated
PSA is really due to prostate cancer.
The most common tests recommended for evaluation of an elevated level of the PSA include an
ultrasound of the prostate through the rectum and a prostate biopsy. Both procedures are
relatively safe but can be uncomfortable. In addition, the biopsy can cause bleeding, infection
and pain. On occasion, a prostate cancer can be missed by the biopsy. Therefore, a number of
men with an elevated PSA will have these expensive and uncomfortable procedures despite not
having prostate cancer or worse yet, not having a prostate cancer detected when it is in fact
present. In addition, even if prostate cancer is detected earlier by using the PSA test, there is no
good evidence from our current medical knowledge that detecting prostate cancer at this stage
will improve your life expectancy or the quality of your life. For these reasons, the US
Preventive Services Task Force and the Canadian Task Force for Prevention both recommend
against using the PSA for screening. Finally, your PSA may be normal but you could still have
prostate cancer and you would be falsely reassured by a normal test.
Besides screening for cancer, are there other reasons to get the PSA?
If you have already been found to have prostate cancer, the PSA is helpful in monitoring for
recurrent cancer. Getting a PSA under these circumstances is a good idea and there is no
controversy surrounding its utility.
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PSA
Is prostate cancer serious?
More than 25,000 American men will die from prostate cancer each year making prostate cancer
the #2 cause of death from cancer in men (so far, lung cancer still kills more men). On the other
hand, the vast majority of men who develop prostate cancer do NOT have any serious
consequences related to the cancer and die of some other cause (like heart disease which is by far
the #1 killer of men over 50 y/o in America). Unfortunately, it is currently impossible to tell at
the time of diagnosis of prostate cancer, which men will die from prostate cancer or have serious
repercussions from the prostate cancer (like bone pain from prostate cancer that has spread to the
bones) and which men will have no serious problems related to the prostate cancer. Since our
current technology does not allow us to differentiate which men will do poorly and which men
will do well, treatment is offered to all men.
How is prostate cancer treated?
Besides simply waiting to see if symptoms develop (an option quite common in other countries),
there are currently 2 different treatment options:
SURGERY: involves complete removal of the prostate gland and the surrounding lymph nodes.
Complications related to this procedure are dependent primarily on the skill of the surgeon but
include death (0-2%), impotence (20%) and incontinence (5%).
RADIATION: involves receiving high doses of X-rays to the pelvic area for 5 days per week for
about 6 weeks. Complications from radiation therapy include injury to intestine (12%),
impotence (40%) and incontinence (8%).
So, should I get a screening PSA or not?
As you just read, there are major organizations on both sides of this issue. Some doctors believe
that PSA testing will be helpful, by finding prostate cancer earlier and thus, potentially curing it.
But other doctors believe that PSA testing may actually be harmful, because most men with
prostate cancer never develop a problem from it and will thus be treated unnecessarily.
Currently, clinical trials are ongoing to help answer the question about who would benefit from
a screening PSA but results from these studies are not yet available. In the interim, it comes
down to a personal choice from each man. No matter what your choice, you can rest assure that
the medical profession has vocal supporters on both sides of the debate. If you still have further
questions, please direct them to your physician or nurse.
How much does a PSA test cost?
At this time, the cost is $89.
Is PSA testing covered by my insurance?
Medicare now pays for an annual screening PSA in all men over age 50. Other health insurers
may or may not cover screening PSA. Most insurers do cover PSA if you already have prostate
cancer and the PSA is being used to detect recurrent cancer. If your health insurer does not pay
for this test, you will be responsible for the cost of this test.
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