PSA Testing

Prostate cancer

Gerald Andriole, MD, a Washington University urologist at Barnes-Jewish Hospital, recommends a risk-adjusted approach to PSA testing for prostate cancer.

In honor of Father’s Day and Men’s Health Week, this week we’re dedicating a series of articles to men—father’s, brothers, sons, uncles and grandfathers—and the health issues important to you. Today, we’re looking at prostate health and the PSA, or prostate-specific antigen, test.

Who needs a PSA test? And when?

Recent news reports have called attention to the issues of prostate cancer and the role the PSA test plays in discovering cancer and calling for treatment. One of our experts in this field, Gerald Andriole, MD, is a urologist and the chief of urologic surgery at the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. He recommends that men take a “risk-adjusted screening” approach to the PSA test.

What is risk-adjusted PSA screening?

Andriole says, “Risk-adjusted screening means making sure men at the highest risk for developing prostate cancer receive regular PSA tests. For the rest of men—the majority—it means getting a baseline PSA test around the age of 45 and then getting screenings every five to 10  years thereafter, according to the rate at which their PSA rises.”

What groups of men are at the highest risk for prostate cancer?

High-risk groups include:

  • African-American men
  • Men with two or more first-degree relatives with prostate cancer, especially if they were diagnosed at age 60 or younger
  • Men in their 40s who have high PSA scores

Andrew Bullock, MD, a urologist at the Siteman Cancer Center, says, “Rates of prostate cancer in African-American men are twice as high as those in other American men.” He continues, “It is very important for African-American men to get their first PSA test between ages 40 and 45. If those results are within acceptable ranges, then at age 50 they should begin getting PSA screenings annually. Men in the other high-risk categories should consider following the same course of screening.”

Is the PSA test harmful?

The PSA test itself is not harmful, but the actions a man may take after receiving test results that indicate high PSA levels sometimes are. A man with an elevated PSA level may decide to have a biopsy and, if cancer is discovered, that may lead to surgery or radiation treatment, which can result in serious adverse side effects like impotence and incontinence. Andriole and colleagues recommend active surveillance for men diagnosed with prostate cancer.

What is active surveillance?

An increasing number of men are taking this option when a biopsy shows a small amount of cancer in the prostate and microscopic examination indicates it has a low chance of growing aggressively.  Instead of opting immediately for surgery, these men and their physicians are taking a wait-and-watch approach. Andriole says, “For these patients, we repeat PSA testing every three to six months. If there is no change or it rises only slowly, we do another biopsy in a year’s time. If the cancer has worsened, then we can begin discussing treatment options.”

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Category: Siteman Cancer Center

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The Siteman Cancer Center at Barnes-Jewish Hospital & Washington University School of Medicine is the only cancer center in Missouri to hold the prestigious Comprehensive Cancer Center designation from the National Cancer Institute and membership in the National Comprehensive Cancer Network. Siteman offers the expertise of more than 350 Washington University research scientists and physicians who provide care for more than 8,000 newly diagnosed patients each year at a main campus in St. Louis and satellite centers in west St. Louis County, St. Charles County and south St. Louis County.

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