About our e-newsletters
- Free e-newsletters
- Mayo Clinic expertise
- We do not share your e-mail address
Housecall, our weekly general-interest e-newsletter, keeps you up to date on a wide variety of health topics with timely, reliable, practical information, recipes, blogs, questions and answers with Mayo Clinic experts and more. Our biweekly topic-specific e-newsletters also include blogs, questions and answers with Mayo Clinic experts, and other useful information that will help you manage your health.
Housecall Archives
Mayo Clinic Housecall
Stay up to date on the latest health information.
What you get
- Free weekly e-newsletter
- Mayo Clinic expertise
- Recipes, tools and other helpful information
- We do not share your e-mail address
Risks
By Mayo Clinic staffThe risks associated with a PSA test are related to what's done in response to the information you get from the test. In other words, does the expected benefit of knowing the results of a PSA test outweigh the potential risks of knowing?
Expected benefit
You might think that any test indicating whether you might have cancer would be beneficial. Indeed, a PSA test can often detect prostate cancer at an early stage.
But to judge the benefit of the test, it's important to know if early detection and early treatment will improve treatment outcomes and decrease the number of deaths from prostate cancer. Most experts argue that there isn't enough evidence to answer this question.
A key issue is the typical course of prostate cancer. If all cases of prostate cancer progressed rapidly and caused poor health and death, then early detection clearly would be a good thing. However, prostate cancer usually progresses slowly over many years, and the majority of cases are diagnosed in men older than age 65. Therefore, a man may have prostate cancer that never causes symptoms or becomes a medical problem during his lifetime.
Limitations of the test
The limitations of the PSA test make it difficult to judge its benefits and risks. These limitations include:
- PSA-raising factors. Besides cancer, other conditions that can raise PSA levels include an enlarged prostate (benign prostatic hyperplasia, or BPH) and an inflamed or infected prostate (prostatitis). Also, PSA levels normally increase with age.
- PSA-lowering factors. Medications to treat BPH and some dietary supplements taken for prostate health can lower PSA levels.
- Misleading results. The test doesn't always provide an accurate result. A positive result on a PSA test — a PSA level high enough to suggest you may have cancer — doesn't necessarily mean you have cancer. And some men with negative results are later diagnosed with prostate cancer.
- Overdiagnosis. Studies have estimated that between 29 and 44 percent of men with prostate cancer detected by PSA tests have tumors that wouldn't result in symptoms during their lifetimes. These symptom-free tumors are considered overdiagnoses — identification of cancer not likely to cause poor health or to present a risk to the person's life.
Potential risks
The potential risks of the PSA test relate to the choices you make based on the test results, such as the decision to undergo further testing and treatment for prostate cancer. The risks include:
- Biopsy issues. A biopsy is an expensive, invasive procedure that carries its own risks, including pain, bleeding and infection.
- Psychological effects. False-positive test results — high PSA levels but no cancer found with biopsy — can produce a significant amount of anxiety or distress. You may be inclined to worry about whether the PSA test or the biopsy was correct. If you are diagnosed with prostate cancer, but it appears to be a slow-growing tumor that doesn't result in illness, you may experience significant anxiety just knowing it's there.
Recommendations
A number of major professional organizations and government agencies have weighed in on the benefits and risks of PSA testing. The American Cancer Society, the American Urological Association, the American College of Preventive Medicine, the Centers for Disease Control and Prevention, and the U.S. Preventive Services Task Force all recognize the controversy surrounding screening with the PSA test and the lack of firm evidence that screening can prevent deaths from prostate cancer. Other points of agreement include:
- Screening needs to be an individualized decision. All of the organizations recommend that doctors discuss the benefits and risks of PSA testing with men at a certain age or in high-risk groups. Doctors should help men make their own decisions about screening, based on age, risk factors, life expectancy and personal preferences.
- Older men generally don't need to be screened. Most organizations recommend that screening isn't necessary for men age 75 and older or those who aren't expected to live more than 10 years. The American Urological Association advises that this decision should be made on an individual basis.
- Men at high risk should discuss screening at an earlier age. Some groups recommend earlier discussions for men in high-risk groups — those with a family history of prostate cancer and African-American men.
The American Cancer Society and the American College of Preventive Medicine recommend that doctors provide information about prostate cancer screening to men starting at age 50. These organizations also suggest that men in high-risk groups could benefit from this information at age 45 or 40, depending on their level of risk.
The U.S. Preventive Services Task Force recommends against PSA-based screening for men who do not have symptoms that are highly suspicious for prostate cancer. The USPSTF states that PSA testing in healthy men, regardless of age, offers no net benefit or that the harms outweigh the benefits.
The American Urological Association recommends that men talk to their doctors about getting a baseline PSA test at age 40. This could help them determine when to screen in the future and to understand possible future risk and test results.
- Prostate-specific antigen (PSA) test. National Cancer Institute. http://www.cancer.gov/cancertopics/factsheet/detection/PSA. Accessed April 5, 2011.
- Prostate cancer: Early detection. American Cancer Society. http://www.cancer.org/Cancer/ProstateCancer/MoreInformation/ProstateCancerEarlyDetection/prostate-cancer-early-detection-pdf. Accessed April 5, 2011.
- Prostate cancer screening. Centers for Disease Control and Prevention. http://www.cdc.gov/cancer/prostate/basic_info/screening.htm. Accessed April 5, 2011.
- Gjertson CK, et al. Use and assessment of PSA in prostate cancer. Medical Clinics of North America. 2011;95:191.
- Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Rockville, Md.: U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/draftrec3.htm#recd. Accessed Oct. 11, 2011.
- Prostate cancer overview. How many men get prostate cancer? American Cancer Society. http://www.cancer.org/Cancer/ProstateCancer/OverviewGuide/prostate-cancer-overview-key-statistics. Accessed April 5, 2011.
- What You Need to Know About Prostate Cancer. Rockville, Md.: National Cancer Institute; 2008. http://www.cancer.gov/cancertopics/wyntk/prostate/page1. Accessed April 8, 2011.
- Guideline synthesis: Screening for prostate cancer. National Guideline Clearinghouse. http://www.guideline.gov/syntheses/printView.aspx?id=16398. Accessed April 5, 2011.
- Shteynshlyuger A, et al. Prostate cancer: To screen or not to screen? Urologic Clinics of North America. 2010;37:1.
- Greene KL, et al. Prostate specific antigen best practice statement: 2009 update. The Journal of Urology. 2009;182:2232.
- AUA Foundation responds to American Cancer Society guideline for the early detection of prostate cancer. AUA Foundation. http://www.auanet.org/content/press/press_releases/article.cfm?articleNo=179. Accessed April 5, 2011.
- Wolf AMD, et al. American Cancer Society guideline for the early detection of prostate cancer. CA: A Cancer Journal for Clinicians. 2010;60:70.
Find Mayo Clinic on