When men reach middle age, they are often struck by the number of tests needed to prevent disease and keep them healthy. One such test that used to be controversial simply because it was misinterpreted but is now very useful is the prostate-specific antigen or PSA test. Let’s briefly touch on the idea of this incredible comeback – PSA was widely used in the 80s and 90s as a measure of prostate and guidance for a biopsy. At the time, we didn’t know much, certainly not as much as we do now, about prostate cancer. Often, these PSA readings were misinterpreted, and the following occurred:
- PSA levels found to be above four, immediately biopsy
- If the biopsy shows any cancer, go straight to the prostatectomy
- Manage post-prostatectomy side effects, including incontinence and erectile dysfunction
As you might imagine, this treat-everything approach led to over-treatment of a cancer that can be alternately slow-growing or very aggressive. When it was recognized that many patients were over-treated, PSA screening became controversial
We now use PSA as a screening test in conjunction with many additional tests including urine and blood genomic markers for prostate cancer as well as a multiparametric prostate MRI to determine which patients need a biopsy. Furthermore, we are also more selective about which patients need treatment if prostate cancer is diagnosed after a biopsy.