Men's Health

What To Think About

• When combined with a digital rectal exam, the prostate-specific antigen (PSA) test may increase the chance of finding prostate cancer. For more information, see the topic Digital Rectal Examination (DRE).
• A PSA level within the normal ranges does not mean that prostate cancer is not present. Some men who have prostate cancer have normal PSA levels.
• The American Cancer Society (ACS) advises men to talk with their doctors about testing and treatment before deciding about testing. The ACS says that men should not be tested without learning about the risks and benefits. The ACS advises talking to a doctor about testing:
  • At age 50 for men who are at average risk of getting prostate cancer and are expected to live at least 10 more years.
  • At age 45 for men at high risk, such as African Americans and men who have a first-degree relative (father, brother, or son) who had prostate cancer when he was younger than 65.
  • At age 40 for men at an even higher risk, such as those with several first-degree relatives who had prostate cancer at an early age.
• The U.S. Preventive Services Task Force (USPSTF) advises doctors about when to test for prostate cancer:
  • No testing is advised for men age 75 and older.
  • Before any tests, it is important for men younger than 75 to talk with a doctor about the pros and cons of PSA testing.
  • Men younger than 75 who have long-term medical problems and who are expected to live less than 10 years are not likely to benefit from testing.
• The American Urological Association (AUA) recommends that men decide with their doctors about screening. If a man decides to be screened, the AUA says he should start at the age of 40 for a "baseline" score (a baseline score is a PSA level that can be used to compare with future test scores).
• Some experts do not advise yearly testing. They say the high rate of false-negative and false-positive results and the costs and risks of further tests outweigh the benefits of yearly screening tests.
• Experts disagree about the type of testing that is appropriate if the PSA level is high. The decision may depend on:
  • Results of your digital rectal exam.
  • Results of any PSA tests you have had in the past. If your PSA level gets higher in a short amount of time, follow-up testing may be recommended.
  • Your age and health.
  • The costs and risks of more tests and treatments.
• Other prostate tests are being evaluated to determine how well they tell the difference between prostate cancer and benign prostatic hyperplasia.
  • The prostate-specific antigen density (PSAD) test compares the PSA value to the size of the prostate gland. The size of the prostate is measured using transrectal ultrasound (TRUS).
  • The PSA velocity test is a measure of how rapidly PSA levels increase over time. PSA levels increase more rapidly in men with prostate cancer and more slowly in men with prostate enlargement (benign prostatic hyperplasia).
  • A complexed prostate-specific antigen (cPSA) test may help show if a prostate biopsy should be done. This test measures the amount of several forms of PSA that are attached to proteins found in the blood.