Your PSA test: Keep score to help find cancer

“Should I or should I not get a PSA test?” This is the question most men are asking after recent reports debate the usefulness of this prostate exam.

“Men should not write off the PSA test,” says John W. Davis, M.D., assistant professor in MD Anderson’s Department of Urology. “It is still an effective way to track trends in your prostate over time. Doing this increases the chances that your doctor will find prostate cancer as early as possible.”

Davis urges men to keep a record of all their PSA test results to discuss with their doctor.

“Reviewing your PSA results over the past four or more years – instead of a one-time number – can help your doctor determine whether you are more likely to get prostate cancer.”

Most men ages 50 to 75 should get tested

The prostate specific antigen, or PSA, test is a simple blood test. It measures the amount of PSA in a man’s bloodstream. PSA is a protein produced by prostate gland cells.

Men should talk to their doctor before getting tested. He or she can explain the possible benefits and risks of prostate cancer screening and treatment. 

MD Anderson recommends that men ages 50 to 75, with no family history of prostate cancer, get a prostate cancer screening exam every year. African-American men and men with a family history of prostate cancer should begin annual screening exams at age 45. Both a digital rectal exam and a PSA blood test should be performed.

If you’re 76 or older, your doctor can help you decide if you still need prostate cancer screening. MD Anderson doesn’t recommend cancer screening for men age 85 or older.

Tips for tracking your PSA levels

“If you decide to do the PSA test after talking to your doctor, start tracking your PSA levels as soon as you begin testing,” Davis says.

He suggests the following tips when recording PSA test results:

• Note the testing standard used to find your PSA level each year. Knowing the testing standard helps doctors compare measurements from one year to the next.
• Ask your doctor for the actual PSA number. Don’t just record the results as normal or elevated.

“Lower PSA levels may suggest you have a lower risk for prostate cancer,” Davis says. “But, a low number, or normal result, does not mean you will not get the disease. This is why tracking trends over time, even among normal results, is so important.”

Monitor PSA trends

When monitoring trends in your PSA levels, Davis suggests looking for these warning signs:

• Doubled PSA score: Has your score doubled in a year?
• Speed of increase over time:The amount of PSA in the blood is measured in nanograms per milliliter. An increase greater than 0.35 nanograms is linked to a higher risk for prostate cancer. Focus on increases over time, or at least one year.
• High PSA score: Between 2.5 to 4 nanograms is considered high and may put you at increased risk for prostate cancer.

Other factors increase risk

“Your doctor also should consider other factors that may increase your chances for developing prostate cancer,” Davis says.

These include:

• Race: Black men get prostate cancer twice as often as white men.
• Family history: Your risk is higher if your brother, son or father had prostate cancer.
• Age: As you get older, your risk increases.
• Abnormal digital rectal exam: An abnormal exam result increases your risk for prostate cancer.

“Remember, not every man should get a PSA test,” Davis says. “Starting at age 40, however, all men should talk to their doctor about this test. He or she can help you decide whether or not the PSA test is right for you as well as when to begin testing.”