The PSA Test May Not Accurately Diagnose Prostate Cancer Lethality

In the latest issue of the Journal of the National Cancer Institute, researchers report that the amount of measured prostate-specific antigen (PSA) may not accurately predict lethality of prostate cancer. The PSA test, which interprets high PSA levels as indicative of prostate growth and/or cancer, is regularly used as a diagnostic test on men aged 50 and over.

The prostate is a walnut-sized organ that surrounds the male urethra. Previously published reports suggested that men with PSA levels of 3.3 nanograms/milliliter or higher have four times the prostate growth rate compared to men with PSA levels of 1.3 nanograms/milliliter or lower. Prostate cancer might be one reason why the PSA levels are higher than normal; however, any abnormal growth, such as benign prostatic hyperplasia (enlarged prostate), could also cause a spike in PSA levels. While an enlarged prostate is not deadly per se, the enlargement itself can cause discomfort and restrict urine flow. Drugs, and sometimes surgery, are then used to slow prostate growth.

When the PSA test results in a diagnosis of cancer, several options are available to the patient. Depending on the age of the man, doctors may actually choose to do nothing, since untreated prostate cancer has a long-term survival rate (in essence, an 80-year-old man may not live long enough to develop full-blown prostate cancer). A younger man, coupled with a higher PSA reading, may be advised to undergo treatment, which would include chemotherapy, surgery (up to and including complete removal of the prostate), or both. While oftentimes the treatment does reverse the cancer, there are serious consequences associated with it, including urinary incontinence, erectile dysfunction, and other quality-of life issues.