Should you get a PSA test?

Like many men, you may wonder if and when you should get a PSA test. There is some conflicting information out there, plus there are claims that the PSA test is inaccurate, leaving some men forgoing this important test and indicator of prostate health. But ultimately, all men should get a PSA test.

What is PSA? PSA stands for prostate-specific antigen, which is produced by cells in the prostate gland. While you usually find PSA in the prostate gland and semen, small amounts of PSA are also found in the bloodstream, where it can be measured by a blood test called the PSA test.

While the PSA test does not tell you whether you do or do not have prostate cancer, a higher PSA may indicate prostate cancer or other prostate problems. Getting a baseline PSA is important because when you get tested again, a change in your PSA can alert you to a possible problem.

What’s the problem with the test?

As mentioned, the results of the PSA test won’t tell you whether you have prostate cancer or prostatitis or some other benign condition. While a high or increasing PSA may indicate prostate cancer, some men have a high PSA and no cancer, just as it is possible to have a low PSA and have a false sense of security when prostate cancer could be present. However, many men learn they have prostate cancer, which often has no symptoms, after having a high or rising PSA. That is why the PSA test is among the top 10 tests that every man over 50 should have.

It is especially important to get a PSA test if you fall in a high-risk group. Men who are over 65, have a family history of prostate cancer, genetic predisposition, are African-American, smoke, are obese, don’t exercise, or eat an unhealthy diet are all at an increased risk for prostate cancer.

People are concerned about the high number of false positives with the PSA test, which may or may not indicate prostate cancer. Because a high PSA may be followed up with a prostate biopsy, there are a lot of unnecessary biopsies performed based on PSA results—in fact 80 percent of men who have prostate biopsies after having a high PSA are happy to learn that their prostate is cancer-free.

But the biopsy itself can lead to complications, not to mention all that unnecessary stress and anxiety that comes with thinking you might have cancer. Plus many of the cancers found are slow growing and low-risk. The good news is that there are newer and upcoming tests that can help men be more informed about their specific cancer if they do have prostate cancer.

Additional tests that improve upon the PSA test

There are some other tests that your doctor should perform to give you a better picture of your prostate health. After you have had a PSA test, your doctor should perform a digital rectal exam (DRE) to feel your prostate with a lubricated, gloved finger. Your doctor may want to perform a prostate biopsy as well.

There are some newer tests available that work with the results of the PSA to give a more complete picture of the patient’s prostate cancer and whether the tumors are aggressive or slow growing. One is a new urine test for prostate cancer.

This test provides patients with more specific information about their prostate cancer tumors. The test scans for two molecular markers that are specific to prostate cancer. This knowledge allows men who have slow-growing tumors to avoid unnecessary treatments and side effects that can affect their quality of life and alert men with more aggressive tumors to take a more informed course of action.

Many men who have a high PSA undergo a prostate biopsy. A new prostate cancer test is helpful for men who have a biopsy. This genomic test is performed on the biopsy sample. It analyzes the genes found in the tumor to find out if the tumor is likely to grow and spread. This helps the patient make informed decisions based on whether the tumor is slow growing (which may indicate active surveillance) or aggressive (which may indicate immediate treatment).

There is also an upcoming new genetic test to predict prostate cancer. The importance of this test will be to help doctors and patients make more informed treatment decisions. This test predicts risk of aggressive prostate cancer based on whether the patient has any of 13 mutations that put him at risk of developing aggressive prostate cancer.

As about half of the 240,000 U.S. men diagnosed with prostate cancer each year are classified as low-risk, the majority of these men choose more aggressive treatments because they do not have enough information about their tumors. Hopefully these new and upcoming tests will help men avoid unnecessary treatment and assist men who need to take action in treating more aggressive cancers.

PSA guidelines

The American Urological Association and the American Cancer Society guidelines for the PSA test are not very aggressive. These guidelines are based on the patient making an informed decision about being tested for prostate cancer. They are also meant to reduce the harm of performing a biopsy on healthy tissue and having the patient worry that he has prostate cancer when he does not.

If you are deciding whether to get a PSA test, you have to weigh your own risk factors, health history, age and lifestyle. Talk to your doctor to determine when you should start testing and how often you should get the PSA test or other tests for prostate cancer. Consider getting checked in your early 40s or even earlier if you are at an increased risk for prostate cancer. Keep a record of your numbers as part of managing your health.

The bottom line is that prostate cancer is the second leading cause of death in men in the U.S. Even men who are as young as their 30s are being diagnosed with prostate cancer. Many men do not know they have prostate cancer until they get the PSA test, which is why it can be an important early warning sign of a cancer you didn’t know was there.

Don’t be worried about getting a false positive. Don’t let that keep you from getting tested. A false positive can be an indication of some other problem going on in your prostate, so you can use that information to improve your prostate health. Other benign conditions such as an enlarged prostate or prostatitis, which can both elevate your PSA, have links to prostate cancer, so being aware of these conditions and managing your prostate health may help you to lower your prostate cancer risk factors. If you are concerned that your PSA level is high and you don’t have an identifiable reason, you can learn how to lower your PSA count naturally through diet and exercise.

What to avoid before the PSA test

If you have an upcoming PSA test there are some activities you should avoid in the 48 hours before the test. Avoid riding a bike, horse, motorcycle or tractor. You should avoid contact sports like karate. Do not get a prostate massage or a DRE, and do not ejaculate. All these activities can temporarily increase your PSA level, and you want the most accurate reading.

Other health conditions can affect your PSA such as taking supplements to boost testosterone, a recent injury or infection, and taking certain medications. Talk to your doctor of you have any of these factors or if you have an enlarged prostate or prostatitis, because these may affect your results.

Dr. Geo Espinosa

By Dr. Geo Espinosa

Dr. Geo Espinosa is a naturopathic doctor, licensed acupuncturist and certified functional medicine practitioner recognized as an authority in holistic urology and men’s health. He is Clinical Assistant Professor and holistic clinician in Urology at New York University Langone Medical Center. As an avid researcher and writer, Dr. Geo has authored numerous scientific papers and books including co-editing the Integrative Sexual Health book, and author of the best selling prostate cancer book: Thrive, Don't Only Survive.