Charles L. Jackson MD
Medical Advisory Board
This is the first in a series of articles in Urology, beginning with the importance of understanding PSA.
Testing blood levels of PSA to screen for prostate cancer was first introduced in 1987. Its’ value for early detection of prostate cancer has been debated since its introduction and especially in recent years. In May 2012, the US Preventative Services Task Force recommended against the use of PSA for prostate screening for all men of all ages. This has caused considerable confusion for patients and their primary care physicians. Many physicians have stopped routine checking of PSA potentially placing their patients at risk. To better understand the value of PSA screening, one must first know what PSA is.
PSA is a normal, benign, harmless protein known as prostatic specific antigen. Antigen is just another word for protein. PSA is nothing more than a protein made only by the prostate. It is a protein specific to the prostate, but not cancer specific. PSA levels however, may be used to estimate a man’s risk for having prostate cancer.
Prostate cancer is the most common cancer in men and is responsible for approximately 27,000 to 30,000 deaths each year. Early, curable prostate cancer is a silent disease. It does not cause symptoms. Symptoms from prostate cancer are produced by late, advanced disease and metastases. Metastatic prostate cancer cannot be cured. If we are to cure prostate cancer we must detect it early. Since early prostate cancer does not produce symptoms, we must look for it. We look for it with a physical exam and PSA blood tests.
Rather than wait for symptoms and advanced disease, men should check a baseline PSA in their forties. It should be less than one. If it is less than one, their risk for developing prostate cancer is very low and they can begin annual or biennial PSA testing at age fifty. If the PSA level is greater than one, or if they are of African-American heritage and/ or have a strong family history of prostate cancer, the PSA should be checked annually while they are still in their forties.