Who Should Get a PSA Test
At What Age Should I Start Getting PSA Tests?
The age at which one should first have a prostate cancer screening has been debated. The recommendations of the American Cancer Society are for all patients over the age of 50 to undergo digital rectal examination and PSA testing. However, few weeks go by in the office without a patient under the age of 30 who requests a prostate cancer screening.
Using 50 as an arbitrary age cut-off is subject to much discussion. Patients who are at high risk for prostate cancer - such as African-American men or those with a strong family history of a father or brother who were diagnosed with prostate cancer prior to age 65 - should begin screening at age 45. Prostate cancer is the second leading cause of cancer death in African-American males. African-American males have a 60% higher incidence of prostate cancer as well as a higher death rate from prostate cancer than white males - 64% vs. 26.2% according to the latest statistics from the American Cancer Society. These facts help support the need for earlier screening amongst this population.
PSA Testing for Older Men
Prostate cancer is a disease that is associated with a higher incidence amongst the elderly. Autopsy studies show that up to 80% of 80-year-old men are found to have prostate cancer. This raises two questions:
- Should PSA testing be routinely performed in all 80 year old men?
- Do all 80 year olds who are diagnosed with prostate cancer require treatment?
The group of patients with autopsy-proven prostate cancer had a fairly non-aggressive, low level of disease that would probably not have caused them any symptoms nor did it lead to their death. This helps support the idea that a large percentage of the elderly may not need treatment for the disease if it were detected. However, for older men with the symptomatic form of the disease, whether it is from localized symptoms or because the disease has spread to other organs such as bone, treatment is warranted.
Who Should Get Treatment for Prostate Cancer?
When deciding upon a treatment for a patient with prostate cancer, the patient’s life expectancy is very important to take into consideration. For a patient to obtain the benefits that are achieved when a patient undergoes definitive treatment such as radical prostatectomy or radiation therapy, the patient’s life expectancy should be at least 10 years, as this is the point post-procedurally that survival benefits will be seen. It is for this reason that oftentimes, a man over 80 with an elevated PSA may go untreated. This group of patients is far more likely to die from a disease other than prostate cancer. Certain situations such as metastatic prostate cancer do warrant treatment in this group of patients; however, these treatments are not intended to cure, but are intended to keep the prostate cancer in control.
Despite the criticism of PSA and PSA testing, it remains the best tool that we presently have to diagnose prostate cancer. It has saved many lives by detecting significant disease early on in many patients who otherwise would have succumbed to this potentially deadly disease. Continuing research will better define the ideal usage of this test and may identify other treatments that will prove useful in fighting this disease.
Jay Motola, MD, is a board-certified urologist and attending physician, Department of Urology, Mount Sinai West, and Assistant Professor of Urology, Icahn School of Medicine at Mount Sinai. Dr. Motola is a summa cum laude, Phi Beta Kappa graduate of Boston University, and earned his medical degree at the State University of New York at Stony Brook.