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Prostate Cancer Screening: Should I Have a PSA Test?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Prostate Cancer Screening: Should I Have a PSA Test?
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
1Get the | 2Compare | 3Your | 4Your | 5Quiz | 6Your |
Get the facts
Your options
- Have a PSA blood test to check for prostate cancer.
- Do not have a PSA blood test to check for prostate cancer.
This information is for people in their 50s and 60s. But it also may be helpful to others who are thinking about this decision.
Key points to remember
- PSA tests can help find some prostate cancers early, when the cancer may be easier to treat. A large study of prostate cancer screening showed that PSA testing may prevent a small number of deaths from prostate cancer.
- A high PSA level can have many causes, including an enlarged prostate, an infection, or, less often, prostate cancer. A high PSA can cause a lot of worry and lead to more tests. But most high PSA test results will not turn out to be from cancer.
- Many cancers found by PSA tests would not have caused a problem if they had not been found through screening. But when they are found, they often get treated with surgery to remove the prostate or with radiation. These cancer treatments may not have been needed. And they can have serious side effects, such as urinary, bowel, and erection problems.
- Many prostate cancers grow slowly. This means that many people with prostate cancer will die of something else before their prostate cancer advances enough to cause any problems.
- With faster-growing prostate cancers, finding the cancer early may not help you live longer. Some prostate cancers will be fatal no matter when they are found or how they are treated.
FAQsWhat is prostate cancer?
Prostate cancer is the abnormal growth of cells in the tissues of the prostate gland, Opens dialog. Most cases of prostate cancer occur after age 65.
Early prostate cancer usually doesn't cause symptoms. When prostate cancer is found before it has spread outside the prostate gland, options include active surveillance, Opens dialog, surgery to remove the prostate, or radiation. If a prostate cancer grows or spreads, symptoms may develop, including urinary problems (such as blood in the urine) and bone pain.
Many prostate cancers grow slowly. This means that many people with prostate cancer will die of something else before their prostate cancer advances enough to cause any problems. With faster-growing prostate cancers, finding the cancer early may not help you live longer. Some prostate cancers will be fatal no matter when they're found or how they are treated.
What is a PSA test?
The prostate-specific antigen (PSA) test is a blood test that measures your level of PSA. The PSA test is usually done to screen for prostate cancer in people who have no symptoms.
PSA is released into the blood by the cells of the prostate gland. A PSA test can show if you have normal or high amounts of PSA in your blood. A high PSA level can have many causes, including an enlarged prostate, an infection, or, less often, prostate cancer.
What are the benefits of having a PSA test?
PSA tests can help find some prostate cancers early. But it may not help you live any longer than if you had no screening.
What are the risks of having a PSA test?
False-positive results
Often the PSA test can show high levels of PSA that aren't caused by cancer (called a false-positive, Opens dialog).
If your PSA test is high, you may need more tests—like a prostate biopsy—to check for prostate cancer. These tests can be harmful. For example, prostate biopsies can cause infections. For a few people, these infections are very serious. These tests can also cause a lot of worry.
False-negative results
PSA tests may miss some cancers. Not all prostate cancers cause a high PSA, so some PSA tests will be normal when there is cancer (called a false-negative, Opens dialog). But the more serious prostate cancers usually do cause a high PSA.
Overdiagnosis
A PSA test can find cancers that would not have caused a problem (called overdiagnosis). You might have this type of cancer, but a PSA test can't tell if the cancer is harmless. So you may get cancer treatment—including surgery or radiation—that you don't need.
What does the PSA test NOT tell you?
A PSA test alone can't tell if you have prostate cancer. This test only shows the level of your PSA. And a PSA test can't tell why your level is high. A biopsy, Opens dialog is the only way to check for prostate cancer.
The PSA test also does not tell you if a cancer is growing fast or slow. Most prostate cancers that are found early are slow-growing. But a few prostate cancers grow fast.
What do numbers tell us about benefits and risks of PSA testing?
Examples of outcomes with and without PSA testing in men ages 55 to 69footnote 1* Outcomes Without PSA testing With PSA testing Prostate cancer deaths in men who were followed over a 13-year period About 6 out of 1,000 men will die of prostate cancer. About 5 out of 1,000 men will die of prostate cancer. Prostate cancers found in men who were followed over a 13-year period About 68 out of 1,000 men will be diagnosed with prostate cancer. About 102 out of 1,000 men will be diagnosed with prostate cancer. Risk of receiving treatment you don't need None About 27 out of 1,000 men may get treatment they don't need.
High PSA results that are not cancer (false-positives)footnote 1, footnote 2* High PSA results that are not cancer (false-positives) Out of 1,000 PSA tests, about 170 will find a high PSA level. Out of those 170 high PSA test results, about 129 will not be from cancer, while about 41 of the 170 will be from cancer.
These numbers are from a large study done on the value of PSA testing. The study was done in Europe and did not include African Americans, who are at higher risk of prostate cancer.footnote 1 A smaller study done in the United States did not find that PSA testing saved lives.footnote 3
*Based on the best available evidence (evidence quality: moderate to high, Opens dialog)
Benefits
The quality of the evidence about PSA benefits is moderate, Opens dialog.
A large study of prostate cancer screening showed that out of a group of 1,000 men ages 55 to 69 who have PSA testing and are followed over a 13-year period:footnote 1
- Prostate cancer is more likely to be found with PSA testing than without PSA testing. About 102 out of 1,000 men who are screened will be diagnosed with prostate cancer versus about 68 out of 1,000 men who are not screened.
- PSA testing may prevent a small number of deaths from prostate cancer. About 5 out of 1,000 men who are screened will die of prostate cancer versus about 6 out of 1,000 men who are not screened.
Risks
The quality of the evidence about PSA risks is high, Opens dialog.
Many cancers found by PSA tests would not have caused a problem if they had not been found through screening. But when cancers are found, they often get treated with surgery to remove the prostate or with radiation. These cancer treatments may not have been needed. And they can have serious side effects, such as urinary, bowel, and erection problems.
Take a group of 1,000 men ages 55 to 69 who have PSA tests. About 27 of these men may get cancer treatment they don't need.footnote 1
PSA tests can show high levels of PSA that aren't caused by cancer (called a false-positive). This means you may need more tests—like a prostate biopsy—to check for prostate cancer. These tests can be harmful. For example, prostate biopsies can cause infections. For a few people, these infections are very serious. These tests can also cause a lot of worry.
Out of 1,000 PSA tests, about 170 will find a high PSA level. But most high PSA levels are not caused by cancer. Out of those 170 high PSA test results, about 129 will not be from cancer, while about 41 of the 170 will be from cancer.footnote 1, footnote 2
Understanding the evidence
Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.
The information shown here is based on the best available evidence.footnote 1, footnote 2 The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive, Opens dialog.
Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment will have a certain result and that 98 out of 100 will not, there's no way to know if you will be one of the 2 or one of the 98.
What do the experts recommend?
Experts have set up guidelines to advise people about prostate cancer screening.
These guidelines are based on a person's age and their risk of getting prostate cancer. Some things that put people at a higher risk include:
- Being African American.
- Having a father or brother who had prostate cancer before age 65.
- Knowing that a gene change, such as BRCA, runs in your family.
Most experts agree on the following age-related recommendations.
Age 40 and under:
People aren't advised to get the PSA test, since testing in this age group causes more harm than good.
Age 40 to 54 years:
- People at average risk aren't advised to get the PSA test, since testing in this age group causes more harm than good.
- Around age 45, people at higher risk may want to talk with their doctors about the pros and cons of testing before deciding whether to get the PSA test.
Age 55 to 69 years:
People who are thinking about getting the PSA test are advised to talk with their doctors about the pros and cons of testing before deciding whether to get the PSA test.
Ages 70 and older:
Most people aren't advised to get the PSA test, since testing in this age group causes more harm than good.
Why might your doctor offer PSA screening for you?
Your doctor may discuss PSA screening if you are in your 50s or 60s. If you're at high risk, your doctor may discuss screening sooner. Some things may put you at high risk for prostate cancer, such as being African American, having a family history of prostate cancer, or carrying gene changes thought to increase the risk for prostate cancer. If you don't already know your prostate cancer risk, you can ask your doctor.
What is prostate cancer?
Prostate cancer is the abnormal growth of cells in the tissues of the prostate gland, Opens dialog. Most cases of prostate cancer occur after age 65.
Early prostate cancer usually doesn't cause symptoms. When prostate cancer is found before it has spread outside the prostate gland, options include active surveillance, Opens dialog, surgery to remove the prostate, or radiation. If a prostate cancer grows or spreads, symptoms may develop, including urinary problems (such as blood in the urine) and bone pain.
Many prostate cancers grow slowly. This means that many people with prostate cancer will die of something else before their prostate cancer advances enough to cause any problems. With faster-growing prostate cancers, finding the cancer early may not help you live longer. Some prostate cancers will be fatal no matter when they're found or how they are treated.
What is a PSA test?
The prostate-specific antigen (PSA) test is a blood test that measures your level of PSA. The PSA test is usually done to screen for prostate cancer in people who have no symptoms.
PSA is released into the blood by the cells of the prostate gland. A PSA test can show if you have normal or high amounts of PSA in your blood. A high PSA level can have many causes, including an enlarged prostate, an infection, or, less often, prostate cancer.
What are the benefits of having a PSA test?
PSA tests can help find some prostate cancers early. But it may not help you live any longer than if you had no screening.
What are the risks of having a PSA test?
False-positive results
Often the PSA test can show high levels of PSA that aren't caused by cancer (called a false-positive, Opens dialog).
If your PSA test is high, you may need more tests—like a prostate biopsy—to check for prostate cancer. These tests can be harmful. For example, prostate biopsies can cause infections. For a few people, these infections are very serious. These tests can also cause a lot of worry.
False-negative results
PSA tests may miss some cancers. Not all prostate cancers cause a high PSA, so some PSA tests will be normal when there is cancer (called a false-negative, Opens dialog). But the more serious prostate cancers usually do cause a high PSA.
Overdiagnosis
A PSA test can find cancers that would not have caused a problem (called overdiagnosis). You might have this type of cancer, but a PSA test can't tell if the cancer is harmless. So you may get cancer treatment—including surgery or radiation—that you don't need.
What does the PSA test NOT tell you?
A PSA test alone can't tell if you have prostate cancer. This test only shows the level of your PSA. And a PSA test can't tell why your level is high. A biopsy, Opens dialog is the only way to check for prostate cancer.
The PSA test also does not tell you if a cancer is growing fast or slow. Most prostate cancers that are found early are slow-growing. But a few prostate cancers grow fast.
What do numbers tell us about benefits and risks of PSA testing?
| Outcomes | Without PSA testing | With PSA testing |
|---|---|---|
| Prostate cancer deaths in men who were followed over a 13-year period | About 6 out of 1,000 men will die of prostate cancer. | About 5 out of 1,000 men will die of prostate cancer. |
| Prostate cancers found in men who were followed over a 13-year period | About 68 out of 1,000 men will be diagnosed with prostate cancer. | About 102 out of 1,000 men will be diagnosed with prostate cancer. |
| Risk of receiving treatment you don't need | None | About 27 out of 1,000 men may get treatment they don't need. |
| High PSA results that are not cancer (false-positives) | Out of 1,000 PSA tests, about 170 will find a high PSA level. Out of those 170 high PSA test results, about 129 will not be from cancer, while about 41 of the 170 will be from cancer. |
These numbers are from a large study done on the value of PSA testing. The study was done in Europe and did not include African Americans, who are at higher risk of prostate cancer.footnote 1 A smaller study done in the United States did not find that PSA testing saved lives.footnote 3
*Based on the best available evidence (evidence quality: moderate to high, Opens dialog)
Benefits
The quality of the evidence about PSA benefits is moderate, Opens dialog.
A large study of prostate cancer screening showed that out of a group of 1,000 men ages 55 to 69 who have PSA testing and are followed over a 13-year period:footnote 1
- Prostate cancer is more likely to be found with PSA testing than without PSA testing. About 102 out of 1,000 men who are screened will be diagnosed with prostate cancer versus about 68 out of 1,000 men who are not screened.
- PSA testing may prevent a small number of deaths from prostate cancer. About 5 out of 1,000 men who are screened will die of prostate cancer versus about 6 out of 1,000 men who are not screened.
Risks
The quality of the evidence about PSA risks is high, Opens dialog.
Many cancers found by PSA tests would not have caused a problem if they had not been found through screening. But when cancers are found, they often get treated with surgery to remove the prostate or with radiation. These cancer treatments may not have been needed. And they can have serious side effects, such as urinary, bowel, and erection problems.
Take a group of 1,000 men ages 55 to 69 who have PSA tests. About 27 of these men may get cancer treatment they don't need.footnote 1
PSA tests can show high levels of PSA that aren't caused by cancer (called a false-positive). This means you may need more tests—like a prostate biopsy—to check for prostate cancer. These tests can be harmful. For example, prostate biopsies can cause infections. For a few people, these infections are very serious. These tests can also cause a lot of worry.
Out of 1,000 PSA tests, about 170 will find a high PSA level. But most high PSA levels are not caused by cancer. Out of those 170 high PSA test results, about 129 will not be from cancer, while about 41 of the 170 will be from cancer.footnote 1, footnote 2
Understanding the evidence
Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.
The information shown here is based on the best available evidence.footnote 1, footnote 2 The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive, Opens dialog.
Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment will have a certain result and that 98 out of 100 will not, there's no way to know if you will be one of the 2 or one of the 98.
What do the experts recommend?
Experts have set up guidelines to advise people about prostate cancer screening.
These guidelines are based on a person's age and their risk of getting prostate cancer. Some things that put people at a higher risk include:
- Being African American.
- Having a father or brother who had prostate cancer before age 65.
- Knowing that a gene change, such as BRCA, runs in your family.
Most experts agree on the following age-related recommendations.
Age 40 and under:
People aren't advised to get the PSA test, since testing in this age group causes more harm than good.
Age 40 to 54 years:
- People at average risk aren't advised to get the PSA test, since testing in this age group causes more harm than good.
- Around age 45, people at higher risk may want to talk with their doctors about the pros and cons of testing before deciding whether to get the PSA test.
Age 55 to 69 years:
People who are thinking about getting the PSA test are advised to talk with their doctors about the pros and cons of testing before deciding whether to get the PSA test.
Ages 70 and older:
Most people aren't advised to get the PSA test, since testing in this age group causes more harm than good.
Why might your doctor offer PSA screening for you?
Your doctor may discuss PSA screening if you are in your 50s or 60s. If you're at high risk, your doctor may discuss screening sooner. Some things may put you at high risk for prostate cancer, such as being African American, having a family history of prostate cancer, or carrying gene changes thought to increase the risk for prostate cancer. If you don't already know your prostate cancer risk, you can ask your doctor.
Compare your options
| Have a PSA test | Don't have a PSA test | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Compare
What is usually involved? | ||
|---|---|---|
What are the benefits? | ||
What are the risks and side effects? |
- You have a blood test to check your PSA level.
- If your PSA is high, you'll need more tests. These may include repeat PSA tests or a prostate biopsy.
- A PSA test can help find some prostate cancers early, when the cancer may be easier to treat.
- PSA testing may prevent a small number of deaths from prostate cancer.
- A PSA test may miss some cancers. Some PSA tests may be normal when there is cancer (called a false-negative).
- A PSA test may show a high level that is not caused by cancer (called a false-positive).
- If your PSA test is high, you may need more tests—like a prostate biopsy—to check for cancer. These tests can be harmful. For example, prostate biopsies can cause infections. For a few people, these infections are very serious. These tests can also cause a lot of worry.
- A PSA test may find cancers that would not have caused a problem (called overdiagnosis). This can lead to cancer treatments that you don't need. These treatments can cause urinary, bowel, and erection problems.
- Instead of having regular PSA tests, you see your doctor as needed or if you have prostate or urinary symptoms.
- You avoid testing that could lead to a diagnosis of cancer and treatments that can cause urinary, bowel, and erection problems.
- You may miss the chance of finding prostate cancer early, when the cancer may be easier to treat.
Personal stories about having a prostate-specific antigen (PSA) test to screen for prostate cancer
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
For me, there is still too much uncertainty about how helpful the PSA test is and how accurate it is. I've read that high PSAs can be caused by things other than cancer. But the only way to check for cancer is to have a biopsy. I don't want to have to go through that if I don't have to. And the fact that I might be treated for a cancer that wouldn't have caused a problem is troublesome. So for now, I'm not going to have the PSA test.
Mike, age 62
I've done some reading on this subject, and I know that I'm a lot more likely to die from my heart disease than from prostate cancer. Right now I'm focusing my efforts on controlling my blood pressure and cholesterol because I know that treating those things can help me live longer and better. I know that if I had the PSA test and it was high, I would just worry and be stressed out.
Pieter, age 67
I have two children who are in high school right now, and both plan to go to college. It's important to me to provide for them and ensure that they have the money they need to finish their education. If I found out I had cancer, I would try any treatment that might offer me a chance to live longer, even if it has side effects. I'm going to have the PSA test.
Eric, age 56
My health is great. I still run, play tennis, and travel a lot. At my age, you start to see friends getting sick and dying of one thing or another, and it makes you start to think about your own health more. I know that the PSA test isn't perfect, but I want to have every chance I can to treat cancer early if I have it.
Jacob, age 68
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Each pair of questions uses a 3 point scale where 3 is more important, 1 is less important and 0 is equally important. Use the right and left arrow keys to navigate the scale.Reasons to have a PSA test
Reasons not to have a PSA test
I want to find prostate cancer early.
I want to avoid the side effects of prostate cancer treatment.
I want to be tested so I can have peace of mind.
I'm not worried that I might get prostate cancer.
I want to know if I have prostate cancer.
I don't want to know if I have prostate cancer, because it may never affect my health.
I think having a PSA test is worth the risk of having a false alarm if it could find prostate cancer early.
I want to avoid worry from a false alarm and more testing.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Use the following 3 point scale where 3 is leaning toward, 1 is may be leaning toward, and 0 is undecided. Use the right and left arrow keys to navigate the scale.Have a PSA test
Do not have a PSA test
What else do you need to make your decision?
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you're leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits and References
Credits
| Author | Ignite Healthwise, LLC Staff |
|---|---|
| Clinical Review Board | Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
References
Citations
- Schröder FH, et al. (2014). Screening and prostate-cancer mortality: Results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet, 384(9959): 2027–2035. DOI: 10.1016/S0140-6736(14)60525-0. Accessed May 5, 2015.
- Schröder FH, et al. (2009). Screening and prostate-cancer mortality in a randomized European study. New England Journal of Medicine, 360(13): 1320–1328.
- Andriole GL, et al. (2012). Prostate cancer screening in the randomized prostate, lung, colorectal, and ovarian cancer screening trial: Mortality results after 13 years of follow-up. Journal of the National Cancer Institute, 104(2): 125–132. DOI: 10.1093/jnci/djr500. Accessed May 8, 2015.
Prostate Cancer Screening: Should I Have a PSA Test?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the Facts
Your options
- Have a PSA blood test to check for prostate cancer.
- Do not have a PSA blood test to check for prostate cancer.
This information is for people in their 50s and 60s. But it also may be helpful to others who are thinking about this decision.
Key points to remember
- PSA tests can help find some prostate cancers early, when the cancer may be easier to treat. A large study of prostate cancer screening showed that PSA testing may prevent a small number of deaths from prostate cancer.
- A high PSA level can have many causes, including an enlarged prostate, an infection, or, less often, prostate cancer. A high PSA can cause a lot of worry and lead to more tests. But most high PSA test results will not turn out to be from cancer.
- Many cancers found by PSA tests would not have caused a problem if they had not been found through screening. But when they are found, they often get treated with surgery to remove the prostate or with radiation. These cancer treatments may not have been needed. And they can have serious side effects, such as urinary, bowel, and erection problems.
- Many prostate cancers grow slowly. This means that many people with prostate cancer will die of something else before their prostate cancer advances enough to cause any problems.
- With faster-growing prostate cancers, finding the cancer early may not help you live longer. Some prostate cancers will be fatal no matter when they are found or how they are treated.
What is prostate cancer?
Prostate cancer is the abnormal growth of cells in the tissues of the prostate gland, Opens dialog. Most cases of prostate cancer occur after age 65.
Early prostate cancer usually doesn't cause symptoms. When prostate cancer is found before it has spread outside the prostate gland, options include active surveillance, Opens dialog, surgery to remove the prostate, or radiation. If a prostate cancer grows or spreads, symptoms may develop, including urinary problems (such as blood in the urine) and bone pain.
Many prostate cancers grow slowly. This means that many people with prostate cancer will die of something else before their prostate cancer advances enough to cause any problems. With faster-growing prostate cancers, finding the cancer early may not help you live longer. Some prostate cancers will be fatal no matter when they're found or how they are treated.
What is a PSA test?
The prostate-specific antigen (PSA) test is a blood test that measures your level of PSA. The PSA test is usually done to screen for prostate cancer in people who have no symptoms.
PSA is released into the blood by the cells of the prostate gland. A PSA test can show if you have normal or high amounts of PSA in your blood. A high PSA level can have many causes, including an enlarged prostate, an infection, or, less often, prostate cancer.
What are the benefits of having a PSA test?
PSA tests can help find some prostate cancers early. But it may not help you live any longer than if you had no screening.
What are the risks of having a PSA test?
False-positive results
Often the PSA test can show high levels of PSA that aren't caused by cancer (called a false-positive, Opens dialog).
If your PSA test is high, you may need more tests—like a prostate biopsy—to check for prostate cancer. These tests can be harmful. For example, prostate biopsies can cause infections. For a few people, these infections are very serious. These tests can also cause a lot of worry.
False-negative results
PSA tests may miss some cancers. Not all prostate cancers cause a high PSA, so some PSA tests will be normal when there is cancer (called a false-negative, Opens dialog). But the more serious prostate cancers usually do cause a high PSA.
Overdiagnosis
A PSA test can find cancers that would not have caused a problem (called overdiagnosis). You might have this type of cancer, but a PSA test can't tell if the cancer is harmless. So you may get cancer treatment—including surgery or radiation—that you don't need.
What does the PSA test NOT tell you?
A PSA test alone can't tell if you have prostate cancer. This test only shows the level of your PSA. And a PSA test can't tell why your level is high. A biopsy, Opens dialog is the only way to check for prostate cancer.
The PSA test also does not tell you if a cancer is growing fast or slow. Most prostate cancers that are found early are slow-growing. But a few prostate cancers grow fast.
What do numbers tell us about benefits and risks of PSA testing?
| Outcomes | Without PSA testing | With PSA testing |
|---|---|---|
| Prostate cancer deaths in men who were followed over a 13-year period | About 6 out of 1,000 men will die of prostate cancer. | About 5 out of 1,000 men will die of prostate cancer. |
| Prostate cancers found in men who were followed over a 13-year period | About 68 out of 1,000 men will be diagnosed with prostate cancer. | About 102 out of 1,000 men will be diagnosed with prostate cancer. |
| Risk of receiving treatment you don't need | None | About 27 out of 1,000 men may get treatment they don't need. |
| High PSA results that are not cancer (false-positives) | Out of 1,000 PSA tests, about 170 will find a high PSA level. Out of those 170 high PSA test results, about 129 will not be from cancer, while about 41 of the 170 will be from cancer. |
These numbers are from a large study done on the value of PSA testing. The study was done in Europe and did not include African Americans, who are at higher risk of prostate cancer.1 A smaller study done in the United States did not find that PSA testing saved lives.3
*Based on the best available evidence (evidence quality: moderate to high, Opens dialog)
Benefits
The quality of the evidence about PSA benefits is moderate, Opens dialog.
A large study of prostate cancer screening showed that out of a group of 1,000 men ages 55 to 69 who have PSA testing and are followed over a 13-year period:1
- Prostate cancer is more likely to be found with PSA testing than without PSA testing. About 102 out of 1,000 men who are screened will be diagnosed with prostate cancer versus about 68 out of 1,000 men who are not screened.
- PSA testing may prevent a small number of deaths from prostate cancer. About 5 out of 1,000 men who are screened will die of prostate cancer versus about 6 out of 1,000 men who are not screened.
Risks
The quality of the evidence about PSA risks is high, Opens dialog.
Many cancers found by PSA tests would not have caused a problem if they had not been found through screening. But when cancers are found, they often get treated with surgery to remove the prostate or with radiation. These cancer treatments may not have been needed. And they can have serious side effects, such as urinary, bowel, and erection problems.
Take a group of 1,000 men ages 55 to 69 who have PSA tests. About 27 of these men may get cancer treatment they don't need.1
PSA tests can show high levels of PSA that aren't caused by cancer (called a false-positive). This means you may need more tests—like a prostate biopsy—to check for prostate cancer. These tests can be harmful. For example, prostate biopsies can cause infections. For a few people, these infections are very serious. These tests can also cause a lot of worry.
Out of 1,000 PSA tests, about 170 will find a high PSA level. But most high PSA levels are not caused by cancer. Out of those 170 high PSA test results, about 129 will not be from cancer, while about 41 of the 170 will be from cancer.1, 2
Understanding the evidence
Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.
The information shown here is based on the best available evidence.1, 2 The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive, Opens dialog.
Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment will have a certain result and that 98 out of 100 will not, there's no way to know if you will be one of the 2 or one of the 98.
What do the experts recommend?
Experts have set up guidelines to advise people about prostate cancer screening.
These guidelines are based on a person's age and their risk of getting prostate cancer. Some things that put people at a higher risk include:
- Being African American.
- Having a father or brother who had prostate cancer before age 65.
- Knowing that a gene change, such as BRCA, runs in your family.
Most experts agree on the following age-related recommendations.
Age 40 and under:
People aren't advised to get the PSA test, since testing in this age group causes more harm than good.
Age 40 to 54 years:
- People at average risk aren't advised to get the PSA test, since testing in this age group causes more harm than good.
- Around age 45, people at higher risk may want to talk with their doctors about the pros and cons of testing before deciding whether to get the PSA test.
Age 55 to 69 years:
People who are thinking about getting the PSA test are advised to talk with their doctors about the pros and cons of testing before deciding whether to get the PSA test.
Ages 70 and older:
Most people aren't advised to get the PSA test, since testing in this age group causes more harm than good.
Why might your doctor offer PSA screening for you?
Your doctor may discuss PSA screening if you are in your 50s or 60s. If you're at high risk, your doctor may discuss screening sooner. Some things may put you at high risk for prostate cancer, such as being African American, having a family history of prostate cancer, or carrying gene changes thought to increase the risk for prostate cancer. If you don't already know your prostate cancer risk, you can ask your doctor.
2. Compare your options
| Have a PSA test | Don't have a PSA test | |
|---|---|---|
| What is usually involved? |
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| What are the benefits? |
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| What are the risks and side effects? |
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Personal stories
Personal stories about having a prostate-specific antigen (PSA) test to screen for prostate cancer
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I have two children who are in high school right now, and both plan to go to college. It's important to me to provide for them and ensure that they have the money they need to finish their education. If I found out I had cancer, I would try any treatment that might offer me a chance to live longer, even if it has side effects. I'm going to have the PSA test."
— Eric, age 56
"For me, there is still too much uncertainty about how helpful the PSA test is and how accurate it is. I've read that high PSAs can be caused by things other than cancer. But the only way to check for cancer is to have a biopsy. I don't want to have to go through that if I don't have to. And the fact that I might be treated for a cancer that wouldn't have caused a problem is troublesome. So for now, I'm not going to have the PSA test."
— Mike, age 62
"My health is great. I still run, play tennis, and travel a lot. At my age, you start to see friends getting sick and dying of one thing or another, and it makes you start to think about your own health more. I know that the PSA test isn't perfect, but I want to have every chance I can to treat cancer early if I have it."
— Jacob, age 68
"I've done some reading on this subject, and I know that I'm a lot more likely to die from my heart disease than from prostate cancer. Right now I'm focusing my efforts on controlling my blood pressure and cholesterol because I know that treating those things can help me live longer and better. I know that if I had the PSA test and it was high, I would just worry and be stressed out."
— Pieter, age 67
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have a PSA test
Reasons not to have a PSA test
I want to find prostate cancer early.
I want to avoid the side effects of prostate cancer treatment.
I want to be tested so I can have peace of mind.
I'm not worried that I might get prostate cancer.
I want to know if I have prostate cancer.
I don't want to know if I have prostate cancer, because it may never affect my health.
I think having a PSA test is worth the risk of having a false alarm if it could find prostate cancer early.
I want to avoid worry from a false alarm and more testing.
My other important reasons:
My other important reasons:
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Have a PSA test
Do not have a PSA test
5. What else do you need to make your decision?
Check the facts
1. Does a high PSA test result always mean you have prostate cancer?
- Yes
- No
- I'm not sure
2. Can a PSA test find cancers that may never cause a problem?
- Yes
- No
- I'm not sure
3. Is there a chance that a PSA test could save your life?
- Yes
- No
- I'm not sure
Decide what's next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
- I'm ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
| By | Ignite Healthwise, LLC Staff |
|---|---|
| Clinical Review Board | Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
- Schröder FH, et al. (2014). Screening and prostate-cancer mortality: Results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet, 384(9959): 2027–2035. DOI: 10.1016/S0140-6736(14)60525-0. Accessed May 5, 2015.
- Schröder FH, et al. (2009). Screening and prostate-cancer mortality in a randomized European study. New England Journal of Medicine, 360(13): 1320–1328.
- Andriole GL, et al. (2012). Prostate cancer screening in the randomized prostate, lung, colorectal, and ovarian cancer screening trial: Mortality results after 13 years of follow-up. Journal of the National Cancer Institute, 104(2): 125–132. DOI: 10.1093/jnci/djr500. Accessed May 8, 2015.
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Current as of: October 25, 2024
Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
This information does not replace the advice of a doctor. Ignite Healthwise, LLC, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.