PSA test for prostate cancer

Some prostate cancers, before they cause symptoms. The test measures PSA, a protein in your blood. A high level can come from cancer, but also from an enlarged or inflamed prostate.

It can miss cancers, and it lowers the risk of dying from prostate cancer only a little: about 5 in 1,000 screened men die of it, compared with 6 in 1,000 men who aren’t screened.

Over 13 years of screening, about 178 in 1,000 men aged 55 to 69 get a high PSA and then a biopsy that finds no cancer, and a biopsy can cause bleeding or infection. Of the 102 men in that group who are diagnosed with prostate cancer, 33 have a cancer that would never have caused illness or death. Because it’s uncertain which cancers will progress, most men choose treatment, which can lead to erection and bladder-control problems.

Ask before the test whether you’ll have to pay. It depends on where you live and where the blood is taken.

The Canadian Task Force on Preventive Health Care recommends against PSA screening because the harms outweigh the small benefit. Its advice is less firm for men aged 55 to 69, who are told to talk with their doctor about the benefits and harms if they’re interested. In Québec, men who want the test are advised to go over it first with a doctor or a specialized nurse practitioner.