Cedars-Sinai Blog

Who Should Get a Prostate Cancer Screening and When?

prostate cancer, screening, testing, age, men, men's health

Once men reach their 50s, many wonder if the safe play is to get screened for prostate cancer, which is the second most common form of cancer in men (skin cancer is #1). Men who have a family history of prostate cancer or other risk factors may even pull the trigger on a prostate-specific antigen (PSA) test while still in their 40s.

The question of when men should start getting prostate cancer screening is somewhat controversial.

Prostate cancer screening can be controversial, and guidelines have gone back and forth, with a recent update coming from the US Preventive Services Task Force in April 2017.

Understanding the controversy

PSA is a protein that's made by the prostate gland and is passed on through the semen as part of normal function in fertility. A PSA test is simple blood test that reveals the level of prostate-specific antigen in a patient's blood.

Even with a healthy prostate, PSA leaks into the bloodstream at very low levels. Anything that causes more leakage raises those levels. Prostate cancer can cause elevated PSA levels, but so can a number of other things, including a naturally large prostate, inflammation, and recent trauma impacting the prostate.

Cedars-Sinai Director, Center for Integrated Research in Cancer and Lifestyle, Stephen J. Freedland, MD.

Dr. Stephen Freedland, a urologist and director of the Cedars-Sinai Center for Integrated Research in Cancer and Lifestyle (CIRCL), explains that there is no doubt that PSA tests can lead to the early discovery of cancers. But testing can also result in false positives, which can lead to unnecessary treatment and testing, including biopsies that carry a risk of infection.

"Can we treat people selectively to reduce the risk of death from aggressive cancers while trying to minimize the harm of picking up indolent cancers or what we call false positives? That's the controversial question."

There is no doubt that PSA tests can lead to the early discovery of cancers. But testing can also result in false positives.

Another option: digital rectal exams

Age and the PSA test

Despite the guidelines, Dr. Freedland recommends that patients in their 40s have the PSA test.

The challenge is that there are no definitively helpful lifestyle changes. The goal is to lower the prostate cancer risk—not just the PSA level. But at the moment, there is no proof that eating a particular diet or losing weight will have that benefit.

Still, many physicians believe that adjustments to diet and weight can reduce the risk of prostate cancer, which is something actively being pursued within CIRCL. That's why, despite the guidelines, Dr. Freedland and others recommend that patients in their 40s have the PSA test.

"It needs to be an informed discussion," he cautions. "But eventually, the majority of American men do get PSA tested. We try to be rational about who we move to biopsy based upon the absolute PSA level and changes over time, family history, race, or other medical problems. We put all of this information together. Personally, at age 45, I had my PSA test done a year ago. It's 'practice what you believe.'"