PSA Testing for Men: Less Can Be More

If you’re a man over age 60, remember this number: 2. That’s likely to be the new cutoff number that shows if your PSA test needs followup.

The PSA blood test for screening men with high risk of prostate cancer has come under a lot of criticism for subjecting thousands of men to biopsies and surgeries that cause impotence and incontinence without any proven benefit of longer life expectancy.

But a new research study says that a simple cutoff number on the PSA test predicts quite accurately which men are likely to get aggressive prostate cancers that need to be cut out. The number is 2.0. It’s not a perfect predictor, but it does put a man in a much higher risk category if he has that result after age 60.

As reported in the New York Times:

About one in four men will have a P.S.A. score of 2.0 or higher at the age of 60, and most of them will not develop prostate cancer, said the study’s lead author, Andrew Vickers, associate attending research methodologist at Memorial Sloan-Kettering. But the score does put them in a higher-risk group of men who have more to gain from regular screening, he concluded.

The higher the score at age 60, the greater the long-term risk of dying from prostate cancer, Dr. Vickers and his colleagues found. Men with a score of 2.0 or higher at age 60 were 26 times more likely to eventually die of the disease than 60-year-old men with scores below 1.0.

Still, the absolute risks for men with elevated scores were lower than might be expected. A 60-year-old man with a P.S.A. score just over 2.0 had an individual risk of dying from prostate cancer during the next 25 years of about 6 percent, the researchers found. A 60-year-old man with a P.S.A. score of 5 had about a 17 percent risk.

“Most of those men are going to be absolutely fine,” said Dr. Vickers. “But they can be told they are at high risk and they need screening.”

Men with a P.S.A. score of 1.0 or lower at age 60 had a very low individual risk of death from prostate cancer over the next 25 years, the study found: just 0.2 percent.

Now, what if you’re in the middle group — with a PSA between 1.0 and 2.0? That puts you in a low risk group — but not so low that you never need to worry. The decision to get the PSA test should depend on your family history and your own fears and concerns.