Should I check my PSA?
The purpose of all screening tests is to catch the cancer early, treat it early, and allow you to live longer, as a direct result of the screening. The PSA is a measure of the amount of antigen or protein the prostate cell sheds. It can go up with an inflammation or infection of the prostate gland, or any manipulation, as a digital rectal examination. There is a number beyond, which it is more suspicious of cancer than otherwise, but the borderline elevations are not clearly related to cancer.
These borderline numbers lead to prostate biopsies. Sometimes these find cancer. This then leads to significant treatment, either external radiation, radiation seed implants or radical prostate surgery. With this, there is a risk of incontinence and impotence, even in the best of hands. If this process saved lives, it would be worthwhile, but this has not been established.
The cancer that is thus diagnosed may not have caused any symptoms for the next 10 years, or even in the man’s lifetime. The value of screening has not been established, as it has been with mammograms for breast cancer. In the US, measuring PSA has been a standard, with no improvement in disease related mortality. In Europe and elsewhere, it is not used as a screening test, but rather a measure of disease, once Prostate Cancer is diagnosed.
It is a useful measure of disease activity, both to measure disease response after therapy, and to watch for relapse.
Then how to watch for initial presentation of Prostate Cancer? With a good digital rectal examination, to check for nodules on the Prostate gland. And, targeting men with high risk, i.e. strong family history of Prostate Cancer.
In the past 20 years, I have asked men who are leading Prostate Cancer experts, whether they have been doing the screening test on themselves. And in the main, the answer has been, no. My bigger peeve with the PSA overuse in the US has been making it a substitute for a rectal examination. The rectal exam serves two purposes; first to check the rectum, and the stool, and second, to check the prostate gland for nodules, which would, need to be biopsied.
Every time a man in my family goes for his annual check up, I remind them to remind their primary doctor, they needed a digital exam, not a screening PSA.