Q & A with Dr. Ian Thompson: PSA Testing for Prostate Cancer (2024)

The Urology Care Foundation is concerned that recent reports about PSA (prostate specific antigen) testing may confuse patients about the value of this prostate cancer screening tool. UrologyHealth extra®sat down with Dr. Ian M. Thompson Jr. to discuss the U.S. Preventive Services Task Force (USPSTF) recommendations on prostate cancer testing.

Dr. Ian M. Thompson Jr. is director of the Cancer Therapy & Research Center at The University of Texas Health Science Center in San Antonio, a National Cancer Institute-designated Cancer Center, and is the former chair of urology. He is the chair of the Genitourinary (GU) Committee of SWOG (a national clinical trials network), a trustee of the American Board of Urology, and chair of the Early Detection Research Network of the National Cancer Institute. In 2012, he received the AUA Hugh Hampton Young Award for outstanding contributions to the diagnosis, control and prevention of prostate cancer.

Q: There has been a lot of talk about the PSA test lately. What exactly is it?

A: PSA, or prostate-specific antigen, was discovered in the early 1970s. It is a protein found in semen and at low levels in the bloodstream of healthy men. In the early 1980s, researchers discovered that high levels of PSA were found in the blood of men with advanced prostate cancer. With this information, the medical community recognized that testing PSA levels in the blood provided an option for early detection of prostate cancer. Before the PSA test, the only way we could test for prostate cancer was the digital rectal exam. This is a physical test where the urologist feels the prostate for abnormalities. Before the PSA test, most men were not diagnosed with prostate cancer until the prostate felt abnormal and it had already spread beyond the prostate. This means that most men were not diagnosed until the cancer had reached an advanced stage.

Q: What is the USPSTF and, in general, what is the purpose of its recommendations?

A: The USPSTF, or U.S. Preventive Services Task Force, makes recommendations about the value of various medical preventive tests. This can be helpful to primary care providers who have a huge number of health issues that they address and thousands of options for which tests to offer their patients. Clearly, they can't offer all of those tests. So many turn to the USPSTF to help them decide which tests are most important.

Q: What recommendation did the USPSTF make about the PSA test, and why are members of the medical community disturbed by this recommendation?

A: The USPSTF makes their recommendations based on results from clinical trials. For the PSA test, they looked at two clinical trials, one in Europe and one in the United States, both during the 1990s. After reviewing the results of these trials, the USPSTF determined that "the benefits [of the PSA test] do not outweigh the harms." In other words, some men's lives were saved. However, the USPSTF does not believe that enough men's lives were saved to justify giving the test to every man.

The important thing for us to note is that the PSA test itself is not harmful. It is a simple blood test. The "harm" that the USPSTF's recommendation is referring to is unnecessary treatment of men that have the type of slow-growing, non-aggressive prostate cancer that is not likely to kill you. The PSA test itself cannot differentiate between these men and the men that have aggressive prostate cancer and are in need of treatment. So the USPSTF has operated under the assumption that each man who gets the PSA test and comes back with high results will be treated as if he has aggressive prostate cancer. The problem is that this is simply not true. Over the past few decades we have learned a great deal about diagnosing prostate cancer. The clinical trials reviewed by the USPSTF were not based on today's procedures and standards. Today we can better predict who ought to have a biopsy after the PSA test and who should not. We are also better able to determine who should have treatment.

Q: How would you counsel a man who is unsure about getting the test?

A: Before having your first PSA test, it is very important to have a conversation about the pros and cons with your physician, and discuss whether the test is right for you. It’s a short conversation as well as a long one. It’s a common disease in a man as he grows older. The average man has about a 1 in 30 risk of dying from prostate cancer. Is that a great enough risk for you to want to take the test to reduce the risk? With the PSA test, we can significantly reduce that risk. Of course it is the responsibility of your physician to use the test intelligently and to clearly explain the results as well as what your options are.

Q: If a man gets the PSA test and his PSA level is high, what should the next step be?

A: One thing I always recommend is that if the test is high you should repeat it—the second time may come back normal. Never make a decision based on just one test. After that, the choice to do a biopsy is based on the PSA level as well as other factors. Family history of the disease, personal health history, life expectancy and race are factored into the decision. (African-American men are twice as likely to develop prostate cancer, and are also more likely to have the aggressive kind.) Then there are a variety of treatment options, including “active surveillance,” or closely monitoring PSA levels for increases over time before continuing with treatment, which may be appropriate for slow-growing prostate cancer.

Q: What is the most important thing our readers should take away from this article?

A: You have the right to decide what’s best for you—be sure to make an informed decision. Have a discussion with your physician. Get all the information you can, and talk about it every step of the way.

Q & A with Dr. Ian Thompson: PSA Testing for Prostate Cancer (2024)

FAQs

What is the average PSA for a 70 year old? ›

2.5-3.5 ng/mL: Normal for men ages 50-60. 3.5-4.5 ng/mL: Normal for men ages 60-70. 4.5-5.5 ng/mL: Normal for men ages 70-80.

How reliable is PSA test for prostate cancer? ›

The PSA test may give false-positive results.

False-positive test results are common with PSA screening; only about 25% of people who have a prostate biopsy due to an elevated PSA level are found to have prostate cancer when a biopsy is done (2).

What is the most accurate test for prostate cancer? ›

Biopsy. If your doctor finds an abnormality during a DRE or MRI, or if PSA testing detects a raised PSA level, you may need a biopsy. A prostate biopsy is one of the most accurate ways to diagnose prostate cancer.

What is an alarming PSA level? ›

Decoding a PSA Test

In general: For men in their 40s and 50s: A PSA score greater than 2.5 ng/ml is considered abnormal. The median PSA for this age range is 0.6 to 0.7 ng/ml. For men in their 60s: A PSA score greater than 4.0 ng/ml is considered abnormal. The normal range is between 1.0 and 1.5 ng/ml.

Why is PSA no longer recommended? ›

PSA tests aren't foolproof. It's possible for your PSA levels to be elevated when cancer isn't present, and to not be elevated when cancer is present.

Does ejaculating lower your PSA? ›

Semen released during sexual activity can cause PSA levels to rise temporarily, which may affect the test results.

What is the new test for prostate cancer? ›

New Prostate Cancer Blood Test

The prostate health index (PHI) is one such test that is a more accurate blood test and measures your risk for having prostate cancer. It's approved by the FDA for men who have PSA scores between 4 and 10. What are the benefits of the PHI test?

What is the best thing to drink for your prostate? ›

Besides teas, other drinks can help improve overall prostate health and potentially reduce symptoms of BPH:
  • Water. Staying hydrated is crucial for overall good health, including that of the prostate.
  • Tomato juice. Tomatoes are a good source of lycopene. ...
  • Citrus juice. Citrus fruits are a great source of vitamin C.
Nov 16, 2021

Why is the PSA test not recommended for men over 70? ›

Expert guidelines don't recommend PSA screening in men 70 and older. Because of their more limited lifespan, these men are less likely to benefit from early detection of low-risk cancer. One reason is that there may be simply less time for the condition to become life threatening in most men.

Does a PSA of 30 mean cancer? ›

CONCLUSIONS: Serum PSA >30 ng/ml is an almost certain predictor of the presence of prostate cancer. Aggressive prostate cancer education and screening programs are needed in our inner cities in order to detect prostate cancer at an earlier, treatable stage.

What is the new MRI for prostate? ›

The multiparametric MRI (mpMRI) is a special type of MRI scan that produces a more detailed picture of your prostate gland than a standard MRI scan does. You usually have an mpMRI scan if doctors suspect that you have prostate cancer.

What is the main symptom of prostate cancer? ›

When symptoms do occur, they can include: trouble urinating or decreased force of stream, blood in the urine or semen, bone pain, unexpected weight loss, and unexplained fevers. If you consistently notice any of these symptoms, you should see your doctor right away.

What is the best drink to lower PSA? ›

Drink green tea

Asian countries where men drink large amounts of green tea have some of the lowest prostate cancer rates in the world. Some studies found the nutrients in green tea were able to protect against prostate cancer and lower PSA levels.

What is the fastest way to lower your PSA? ›

People can naturally lower prostate-specific antigen (PSA) levels by eating plenty of fruits and vegetables, increasing physical exercise, and reducing stress. Maintaining a healthy prostate gland is essential as people age.

Is a PSA test enough? ›

The PSA test is a blood test to help detect prostate cancer. But it's not perfect and will not find all prostate cancers. The test, which can be done at a GP surgery, measures the level of prostate-specific antigen (PSA) in your blood. PSA is a protein made only by the prostate gland.

What is the normal PSA for a 70 year old man in NHS? ›

Reference range: PSA cut-off values (Local referral guidelines, NICE NG12). Age below 40: use clinical judgement; Age 40 – 49 years: 2.5 ug/L; 50 - 59 years: 3.5 ug/L; Age 60 - 69 years: 4.5 ug/L; Age 70 – 79 years: 6.5 ug/L; Age 80+ years: see local advice.

Is a PSA level of 4.7 high? ›

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%.

Is a PSA level of 25 high? ›

A percent-free PSA above 25% is considered normal. Some doctors recommend that if you have a percent-free PSA of 18% or less you should have a prostate biopsy. Other doctors recommend having a biopsy if the percent-free PSA is around 12% or less.

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