Gilmer Free Press

Ask the Doctor: Pros and Cons of PSA Tests

DEAR DR. DONOHUE: I am 82.
At this late stage, I am now being told that a PSA test (that I’ve always had and always passed well within limits) is no longer recommended.
What is a guy to do?
Early detection has always been encouraged, so how am I to know if I will need treatment? - F.O.

ANSWER: The value of the PSA (prostate specific antigen) for the detection of prostate cancer has aroused a great deal of discussion and debate.
Your premise about the early detection of cancer is true for most cancers.
It isn’t always true for all the forms of prostate cancer.
PSA isn’t a perfect test.
It can yield normal results when a man has prostate cancer.
It can yield abnormal results when a man’s cancer requires no treatment or when no cancer is present.
A high proportion of older men - perhaps as many as 90% of men in their 80s - have areas of prostate cancer in their gland.
Quite frequently, that cancer is the kind that grows slowly and doesn’t lead to death. However, a high PSA almost always is followed by a prostate biopsy and often a form of treatment - surgery or radiation.
The complications of treatment can be worse than having a low-grade prostate cancer.
Loss of bladder control, erectile dysfunction and radiation burns are some of those complications.
Your doctor has advised against continued testing for the above reasons.
Screening benefits younger men and men at great risk of developing prostate cancer.
Black men are more likely to have it than are white men.
Some authorities feel that only men with a life expectancy of 10 or more years ought to have regular PSA tests.
All medical professionals encourage men to discuss the pros and cons of PSA testing with their doctor.
If you feel anxious about not having the test, you can request that one be done.

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