Prostate Health and Your PSA –What Men Need to Know

Prostate cancer is one of the most common cancers in men and some of them are among the deadliest. In fact, it’s second only to lung cancer deaths, killing 27,000 - 30,000 men every year. It’s silent in the early stages. When symptoms develop, it’s often a more advanced form of the disease or the cancer has spread to other areas of the body.   

PSA or prostate specific antigen test is a simple blood test used to screen for prostate cancer.

PSA isn’t a cancer-specific protein. It’s a measure that’s used in context with other risk factors to help estimate a man’s risk of having prostate cancer. Because it’s a painless test, men over 40 should discuss with their doctor whether they should be screened (especially those of African American ancestry or a family history of prostate cancer). If a man’s PSA is elevated or if levels rise sharply over time, it could indicate cancer and should be evaluated more closely.

That’s why it’s important for men to see their physician regularly and to understand guidelines for PSA tests – because prostate cancer is highly variable, not every kind needs to be treated. But it is important for health care professionals to know the type and severity of cancer to apply the most effective treatment strategies based on each man’s personal health history.

If prostate cancer is found

Prostate cancer treatment comes with certain known risks – especially for younger men who have a longer life expectancy. These include urinary incontinence, erectile dysfunction and bowel urgency, whether men are treated with surgical removal of the prostate or radiation therapy. Men with intermediate or high-risk prostate cancer typically have minimally invasive prostate removal surgery, radiation or a combination of the two. Men who have a low risk of progression may be placed under active surveillance, or an approach that carefully and actively watches the cancer. For men in this risk category, active surveillance minimizes the short- and long-term risk of complications.

It’s normal for men to have anxiety around active surveillance as opposed to immediate and definitive treatment – especially for men who have a family member or friend who has died of the disease. When there is a low risk of cancer progression, genetic testing options are also available to help understand if there’s a greater risk. If testing shows a high risk of progression – even when the cancer is in the early stage – definitive treatment to remove the cancer may be considered.

Although there is no absolute consensus on the best way to surveil men with a low progression risk of prostate cancer, PSA screening is recommended every four to six months, followed by an annual biopsy or annual MRI if there is no evidence of PSA progression. If a man’s PSA is unstable, surveillance tactics are performed more frequently.

The bottom line: a PSA is used to screen and monitor for disease and provides important information your physician needs to make sound recommendations for your health. Prostate cancer treatment is about shared decision making, and it’s important to talk openly with your physician about risk, including your personal health history, family history of prostate cancer and your expectations for treatment and outcomes.