AARP Hearing Center
Do I Need a Prostate Cancer Screening Test?
A doctor’s advice on when men should get their PSA test
Video: Dr. Adam Rosenbluth explains why your doctor orders more comprehensive tests as you age.
I just turned 55. Should I take a PSA test?
Yes, you should take a PSA test to measure the amount of prostate-specific antigen (PSA) in your blood. One hundred percent. In fact, I usually start screening my patients around the age of 40, because I see an increasing number of young men developing prostate cancer. Early in my career, I diagnosed a patient with prostate cancer when he was just 47 years old.
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If you have a prostate, you have around a 13 percent chance of getting prostate cancer at some point in your life, according to the Centers for Disease Control and Prevention. For these reasons, even though the American Cancer Society recommends men at average risk get their first PSA test at age 50, I prefer not to take chances and suggest earlier screening.
The same thinking applies to older men. Although some guidelines talk about not routinely checking PSA’s in men beyond their 70s, President Biden’s recent diagnosis of aggressive prostate cancer highlights the fact that many men are living longer. This is an opportunity for the health care community to take better care of our aging Americans by individualizing cancer screenings.
The risk factors for prostate cancer include: age (increases as you get older), racial background (African American and Caribbean men of African descent are at higher risk), smoking and obesity, as well as genetics. Having a father or brother with prostate cancer will double your risk of developing the disease.
Now that you know why I recommend earlier PSA screenings, let’s look at what a healthy prostate does. The prostate is a gland around the size of a chestnut located directly below the bladder and above the muscles of your pelvic floor. This gland is crucial for the reproductive process because it releases a liquid when mixed with sperm that produces semen. The prostate’s muscles contract to expel semen during ejaculation.
Your doctor most likely feels your prostate during a digital rectal exam (DRA) as part of your annual physical. It will be checked for lumps, bumps, nodules and areas of hardness and enlargement. But prostate cancer may not produce any symptoms in its early stages — and that’s why a PSA blood test is so important.
If your PSA rises above the number 4, it’s considered to be high, but you should look at the numbers within a context. For example, it’s important to keep in mind that a high reading, especially in older patients, does not necessarily mean that you have prostate cancer. (The U.S. Preventive Services Task Force recommends against screening for prostate cancer after age 70.) It might indicate prostatitis, which is a benign inflammation of the prostate. Or a high number can mean you have a urinary tract infection. If the number spikes dramatically, it’s more concerning than if the number rises slowly.
And guys, I recommend all my male patients see a urologist, a doctor who specializes in the urinary tract and men’s reproductive systems. After all, women make annual appointments with their gynecologist. Why shouldn’t men routinely visit their urologist?
Some of my patients hesitate because they’re afraid a visit might be painful. I want you to know that changes have been made in the way urologists look at prostate issues. In the past, if prostate cancer was suspected, it was common for urologists to perform an uncomfortable biopsy. Now, more often, they’ll opt for a painless MRI or ultrasound as the initial diagnostic tool.
When you have a non-cancerous enlarged prostate, medications can help, but they may have side effects that include reducing sex drive and affecting the flow of semen. Discussing the pros and cons of any medication with your doctor is always a good idea.
If your PSA test and follow-up MRI or ultrasound indicate prostate cancer, treatment options can include surgery, radiation, hormone and chemotherapy, as well as cryotherapy, which freezes and kills the cancer cells. If the cancer is small, slow-growing and contained in the prostate, your urologist might recommend a “wait-and-see” approach. This approach might also be warranted if you have other health issues or are an older patient.
When you’re diagnosed and treated early for prostate cancer, your chances of living your life cancer-free are excellent, as high as 99 percent, according to the Prostate Cancer Foundation. Since a PSA test is painless, usually covered by insurance or Medicare, and can save your life, without hesitation, I say — if you’re 40 years or older — go for it!
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