The PSA and How We Use It

PSA test held by person in glove

Prostate-specific antigen, or PSA, was discovered in 1970, and a purified form that could be used for diagnostics was developed in the 1980s. PSA measurement started as a way to track the effectiveness of prostate cancer treatment but, in the early 1990s, quickly became the definitive first-line diagnostic measure for prostate cancer. PSA is unique in that it is only produced in the prostate, and levels can fluctuate based on the health of the prostate. In fact, much of the reduction in prostate cancer mortality since the 1980s has been attributed to PSA screenings.

However, early on, patients with elevated PSA were often biopsied as a matter of course. Then, when prostate cancer was found, they were referred, amongst other treatments, to surgery in the form of a prostatectomy. This started an era of overtreatment of prostate cancer. We now know that many cases of prostate cancer are not aggressive, and some men may even be able to live normal lives with prostate cancer and routine watchful checkups, never needing to treat it in their lifetimes. We also know that using a single PSA reading makes this testing method unreliable in predicting clinically significant prostate cancer.

The result was that many men were unfortunately rendered impotent and incontinent due to prostate cancer surgeries that were the standard of care at the time, but we now know to have been unnecessary. We still see some patients that implant inflatable penile prostheses years or decades after becoming impotent due to prostatectomy.

Upon analysis by a U.S. Preventative Task Force in the 2010s on the effectiveness of screening (including PSA), there were some damning results in a report that was subsequently used to campaign against this test. Of course, there were some significant limitations, including no urologic specialist being on the task force and the use of older data from the times of overtreatment. For a while, it seemed that PSA, as a front-line diagnostic tool, would be relegated to the history books. Fortunately, this was not to be the case.

Modern PSA Testing

In what can only be described as a stunning turnaround for PSA testing, we now consider PSA to be one of the most accurate diagnostic tests in urology, and maybe all of medicine, not because of a single reading but because of how they trend. Today, we use a series of two or three PSA readings to understand whether the prostate should be biopsied and, ultimately, if prostate cancer should be treated. With this newfound knowledge and a deeper understanding of the art of PSA trend testing, we are better able than at any time in the past to differentiate clinically insignificant prostate cancer from that which needs biopsy and treatment.

Of course, prostate cancer still exists, and tens of thousands of men die each year due to aggressive forms of this cancer. Along with better diagnostic tools, we need men to prioritize prostate cancer screening, which is not only simple but less invasive than many other cancer screenings.

Next Steps

Prostate cancer is insidious because it often does not show symptoms until it has reached a more advanced stage. The first step toward improving prostate health and early cancer detection is speaking to your primary care physician or a men’s health urologist like Dr. Kapadia to understand your risk for prostate cancer and develop an appropriate screening plan. It is worth noting that lower urinary tract symptoms like urgency, frequency, the inability to empty the bladder fully, and more are typically due to a benign condition known as benign prostatic hyperplasia or enlarged prostate and are rarely caused by prostate cancer.

As such, we encourage you to visit Dr. Kapadia for a consultation on your prostate health and to learn more about how to screen for prostate cancer and manage those findings.