Q: I just turned 70. Should my doctor continue to check my PSA?
A: The prostate-specific antigen (PSA) test is likely the most controversial screening test of all time for two reasons.
First, although it is routinely used to test for prostate cancer in men 50 and older, most cases found are clinically insignificant. This means that only about 3 percent of those diagnosed with prostate cancer will die of the disease.
At least 80 to 85 percent of those with detected prostate cancer who choose no treatment will likely die of something else over the next 15 years.
Second, the PSA test has a false-positive rate of 70 percent. This occurs when the test falsely identifies the presence of prostate cancer.
It can only be ruled out conclusively with a biopsy.
Because of these concerns, several medical societies have adopted specific guidelines for using the PSA test.
The American Academy of Family Physicians and the U.S. Preventive Task Force recommend no PSA testing at all.
The American College of Physicians, American Urological Association and American Cancer Society generally recommend that patients and their doctors make the decision together, based on the risks and benefits of using PSA for prostate screening.
Most physicians do not perform PSA screenings after age 69.
With my patients, I do not recommend PSA testing, as long as they have had previous normal PSAs. The decision to have a PSA test before age 70 is one we make together.
There are no clear guidelines for performing PSA screenings at age 50 or even a little earlier if the patient has a higher than average risk for prostate cancer.
Patients whose tests show an elevated PSA should discuss their options with a urologist.
These specialists have tools available that might allow them to detect prostate cancer without a biopsy.
They might also provide closer monitoring of patients’ PSA levels; however, patients should consider the added costs of seeing a specialist and additional imaging.
Since medicine is moving to a value-based payment system, there has also been some threat by Medicare to penalize doctors financially if they order PSAs, especially for patients over the age of 70.
In light of these variables, I do not think men should view the PSA test as a high priority in maintaining their health. But, ultimately, the decision should be yours.
Dr. William E. Kyle is an internal medicine physician at Memorial Health University Physicians – Legacy Center in Okatie.