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Yay or Nay on PSA?

NCH physician weighs in on PSA testing with facts for men over 50

To PSA or not to PSA? If you're 50 or older, odds are this question has crossed your mind.

Proponents stress that PSA testing—a measure of the prostate-specific antigen protein in the blood—can catch prostate cancer early. Opponents caution against regular testing, citing risk of complications and the rate of false positives or false negatives.

David A. Guthman, MD, a board-certified urologist with Northwest Community Healthcare Medical Group, wades right into the PSA controversy with a "just the facts" approach that might surprise you. Read on, men—this one's for you.

Fact: Prostate cancer is the No. 2 cause of cancer death in men.

About one man in six will have a prostate cancer diagnosis in his lifetime. "It is the No. 1 non-skin cancer in men. Prostate cancer has got to be something that's respected," Dr. Guthman says.

Fact: The higher a man's PSA level, the more likely he is to have prostate cancer.

An elevated PSA also may signal other noncancerous prostate problems, such as an infection or an enlarged prostate. "When a patient's PSA comes back high, this does not mean you have prostate cancer. It means you need to be evaluated," Dr. Guthman says. Tests include ultrasound, biopsy or follow-up PSA.

Fact: Most men with elevated PSA do not have prostate cancer.

According to the National Cancer Institute, 25 percent of men who have a prostate biopsy after an elevated PSA score actually have prostate cancer.

Fact: PSA testing is not a perfect test.

"The reason we screen for PSA is we want to catch cancers early while they are asymptomatic. If we catch cancers early, those are the ones we can hopefully cure. We can increase the quality and duration of patients' lives," Dr. Guthman says.

Fact: Talking about PSA with your doctor is smart.

"What's important is that you have a relationship with a caregiver—a PCP or urologist—and that you accept there is a role for screening. The benefit of screening is far better than not detecting cancer," Dr. Guthman says.

David Guthman, MD

David Guthman, MD

Urologist at NCH

  • Board-Certified: Urology
  • Medical School: Northwestern University
  • Internship and residency: Mayo Clinic

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Last Updated 04/10/2009