Should I Have a PSA Test?

Friday, 02 Aug 2013 09:59 AM

By Peter Hibberd, M.D.

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Question: With all the debate over PSA, I’m confused about whether I should get it done or not? I’m 53 and my father was diagnosed with prostate cancer about 10 years ago. 
 
Dr. Hibberd’s answer:
 
The debate over the PSA test has unfortunately has been picked up by the print media and sensationalized. Here is the low down: I agree with screening for you to establish a baseline PSA level, then you should have follow-up screenings at regular intervals based upon your risks and your family history.
 
The concern has been that many victims of prostate cancer may have been over-treated. The new debate reflects a consensus that we need to determine whether a particular case of prostate cancer is aggressive before committing to harmful and uncomfortable prostatectomy or other invasive treatment, for a condition that is not always life-threatening.
 
The PSA does not need to be an essential yearly test for all men, regardless of risk. Risk assessment and hopefully soon the addition of genetic markers will help us use the PSA test more sensibly. Remember the PSA elevates in benign and malignant disease of the prostate, and may not be positive in all men with prostate cancer.
 
Still, the PSA test has revolutionized management and treatment of prostate conditions in men, and has greatly simplified diagnosis that had previously depended upon more elaborate tests, including biopsies. Since the advent of the PSA, there has been a plethora of new treatments for benign prostate hypertrophy (enlarged prostate). These treatments are often guided by PSA and rectal /urine examinations, and have significantly reduced the frequency of prostate surgery (known as TURP).
 
The PSA has been advocated as a screening tool for prostate cancer, but it is important to realize that this test is no longer recommended annually on all men. I believe in establishing baseline values, and periodic monitoring in at-risk individuals only, is probably the best way to go.

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