How to Screen for Prostate Cancer

Key Takeaways

PSA is cheap and effective means to track your risk of prostate cancer.
You should include a PSA test in your annual blood work after age 40 because of its low cost, high value, and negligible risk.
Establishing a baseline PSA measurement in your early 40’s allows you to track it over time with greater confidence.

Introduction

Managing the risk that prostate cancer poses to your health requires taking a proactive approach to screening. It’s imperative to educate yourself about the different types of tests available. And, working collaboratively with your doctor, you must advocate for yourself in developing your screening strategy.

Healthcare providers and diagnostics labs offer a variety of tests to screen for prostate cancer.

While it’s necessary to talk to your doctor, doctors vary in their training, information, clinical judgment, and attention to detail. As a result, their recommendations will often differ. And you alone will face the consequences of suboptimal medical attention.

The services available to screen for prostate cancer include:

1. Family history analysis
2. PSA test
3. PSA density
4. PSA velocity
5. Free PSA
6. Digital exam
7. Multiparametric MRI
8. BRCA 1/2 tests
9. Minus 2 Pro PSA
10. 4K blood test
11. Prostate health index
12. PSMA PET scan
13. Genomic tests
14. Biopsy

Types of Prostate-Cancer Tests

PSA Test

What is the PSA test?

The PSA test measures the amount of prostate-specific antigen (PSA) in the blood.

What is the role of PSA in the body?

The primary role of the prostate gland is to produce semen, the white fluid that surrounds sperm. PSA contributes to the reproductive process by liquifying semen so that it can be ejaculated during sexual intercourse. PSA is, therefore, an important component of a healthy prostate.

Why is PSA referred to as an antigen?

It’s normal for someone to find the use of the word antigen in PSA a bit misleading.

Antigens are substances that the immune system recognizes as foreign and can elicit an immune response. Bacteria and viruses are examples of antigens.

However, the term antigen can also apply in a different way. In clinical diagnostics and research, antigens can also refer to how scientists have developed tests using antibodies to detect and measure them.

Antibodies are specialized proteins produced by the immune system in response to antigens.

In the case of the PSA test, the test actually uses antibodies to measure PSA levels.

In other words, even though the prostates of healthy adult males naturally produce PSA and PSA doesn’t provoke an immune response in these people, tests exploit the fact that, in a laboratory setting, antibodies can detect PSA. Given that antibodies, by definition, detect antigens, scientists therefore categorize the PSA protein as an antigen.

So why is the PSA test used to detect prostate cancer?

When healthy prostates produce PSA, a small amount of it leaks into the blood. However, when a prostate grows enlarged due to benign enlargement, prostatitis, or cancer, it produces more PSA. And more of that PSA leaks into the blood. Furthermore, a prostate that remains a normal size but develops a cancerous lesion also produces more PSA that leaks into the blood. Therefore, a PSA test is not a conclusive test for cancer. But an elevated PSA level indicates that a patient should undergo further tests to determine the cause of the increased PSA level in the blood.

Urologists will consider the results of these tests along with family history to recommend a course of action. Relevant family history includes diagnoses of prostate cancer among fathers, uncles, and brothers. It also includes the age of diagnosis and specific characteristics of those cancers where possible.

However, different urologists can interpret the same data differently and offer different recommendations. These recommendations can have a dramatic impact on a patient’s long-term health. It is therefore critical that patients be their own advocates in educating themselves about prostate health and seek high-quality medical and second opinions when recommendations diverge from best practices.

What are typical PSA test results?

Recommendations on how to interpret PSA test results differ depending on who you ask.

According to Ted Schaeffer, MD, PhD, head of urology at Northwestern University, the median PSA score is 0.5 ng/mL for a 40 year old and 1.0 ng/mL for a 50 year old [X].

According to the American Cancer Society, there is no specific value that indicates if a man does or doesn’t have prostate cancer [X]:

Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if someone requires further testing, while others might recommend it starting at a lower level, such as 2.5. And some doctors might use age-specific cutoffs.
Most men without prostate cancer have PSA levels under 4 ng/mL of blood. When prostate cancer develops, the PSA level often goes above 4. Still, a level below 4 is not a guarantee that a man doesn’t have cancer. About 15% of men with a PSA below 4 who receive a biopsy will have prostate cancer.
Men with a PSA level between 4 and 10 (often called the “borderline range”) have about a 1 in 4 chance of having prostate cancer.
If the PSA is more than 10, the chance of having prostate cancer is over 50%.

How often should an individual receive a PSA test?

Medical guidelines also vary on the frequency of PSA testing.

According to the American Urology Society:

Clinicians may begin prostate cancer screening and offer a baseline PSA test to people between ages 45 to 50 years
Clinicians should offer prostate cancer screening beginning at age 40 to 45 years for people at increased risk of developing prostate cancer based on the following factors: Black ancestry, germline mutations, strong family history of prostate cancer
Clinicians should offer regular prostate cancer screening every 2 to 4 years to people aged 50 to 69 years

By contrast, the American Cancer Society recommends that if no prostate cancer is found as a result of screening, the time between future screenings depends on the results of the PSA blood test. Specifically:

Men who choose to be tested who have a PSA of less than 2.5 ng/mL may only need to be retested every 2 years
Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher

Meanwhile, physician and longevity guru Peter Attia, MD, argues that since the PSA test is basically free and poses no risk to patients, men should get it once a year starting at age 40.

Opponents to this view often say that annual testing leads to overtreatment of prostate cancer, including unnecessary prostate biopsies, a procedure that carries considerable risk.

However, given that PSA test results fluctuate and a competent urologist with up-to-date knowledge would administer other tests (described below) before recommending a biopsy, annual PSA tests potentially offer significant benefits and little risk.

Are there specific brands of PSA tests?

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“An ounce of prevention is worth a pound of cure.” — Benjamin Franklin