How’s your prostate health? Are you keeping tabs on it? Prostate cancer is the most common type of cancer in American men, aside from skin cancer, and it’s most often diagnosed in men over 65. In fact, about 60% of cases are in men within this age group. By tracking changes in your prostate-specific antigen (PSA) levels over time, you could catch potential health issues early and take steps for detection or treatment. Still, routine annual PSA screenings have been the subject of some debate regarding their risks and benefits.
While increased PSA levels are often seen in men with prostate cancer, a high reading doesn’t always mean cancer is present. This has sometimes led to unnecessary biopsies and treatments that could result in negative side effects. So, is it worth getting tested? The PSA test isn’t perfect, but it can help reduce your chances of dying from prostate cancer if used appropriately. The decision to check your PSA is a personal one and can be complex, so it’s important to have open discussions about it with your doctor. Together, you can weigh the pros and cons, as urologists are careful to screen and monitor patients thoughtfully.
### Understanding PSA Tests
A PSA test is a simple blood test that measures the amount of PSA, a protein produced by the prostate gland, in your bloodstream. This protein plays a role in helping sperm move efficiently to increase the chance of fertilization. It’s produced by both healthy and cancerous tissue in the prostate, and some of it naturally enters your blood.
Before a digital rectal exam (DRE), a lab will draw a small amount of blood for the PSA test. Afterward, your doctor will review the results and perform the DRE to check the size of your prostate and look for any lumps or abnormalities.
### When Should You Start Testing?
It’s recommended to begin discussions about prostate cancer screening around age 45. African American men and those with a family history of prostate cancer might need to start these conversations earlier.
### What’s a “Normal” PSA Level?
There’s no universally “normal” PSA level. The amount can vary from person to person and even change over time. PSA results are best interpreted by considering factors like your age, prostate size, race, and the results of your DRE.
### Why Might PSA Levels Be High?
Elevated PSA levels don’t always point to cancer. Other common reasons for high PSA levels include benign prostatic hyperplasia (BPH), which is an enlarged prostate and particularly common in men over 50, infections, sexual activity, prostate inflammation, or having a DRE right before the blood test.
### The PSA Test Controversy
The debate started in 2012 when the U.S. Preventative Services Task Force (USPSTF) advised against routine PSA tests, citing potential harms like unnecessary biopsies. This guidance was revised in 2018 to recommend that men aged 55-69 talk with their doctors about the risks and benefits before deciding. These changes created confusion for both healthcare providers and older men wondering if they needed testing.
Since PSA screenings became less common, there’s been a rise in metastatic prostate cancer cases, suggesting a link between the updated screening guidelines and delayed diagnoses. While biopsies are still the only surefire way to confirm cancer, there are newer tools available to help decide whether a biopsy is truly needed. Not every prostate cancer diagnosis results in treatment, which helps avoid unnecessary side effects.
### Should You Get Screened?
Ultimately, the choice to get screened is yours. If you’re unsure or have concerns, talk to your doctor. Having this conversation doesn’t mean you’re committing to the test—it’s a step to better understand your options and make the decision that feels right for you.