Rates of Advanced Prostate Cancer Have Gone Up Since Recommendations Started Advising Against PSA Test

The USPSTF stopped recommending the PSA test for men 75 and older in 2008, and extended those recommendations to all men — urging them instead to have discussions with their doctors about risk, and then decide whether the test was worth it — in 2012.

The study, published in the Journal of the National Cancer Institute, found that while rates of early-stage prostate cancer are consistently going down — rates of advanced disease in men over the age of 50 are consistently on the rise. Researchers looked at prostate cancer rates between the years of 2005 and 2016 — when federal guidelines began to change — to come to these conclusions.

“Regional- and distant-stage prostate cancer incidence continue to increase in the U.S. in men aged [50 and over], and future studies are needed to identify reasons for the rising trends,” study authors wrote.

What is the PSA Test?

The simple blood test can be used to screen for prostate cancer in men who may be at risk of developing the disease, and can also track how men who have already been diagnosed are responding to treatment.

Some of the top urologic oncologists in the U.S. explain what the PSA test is, and the reasoning behind its controversy.

The USPSTF recommendations against the test came because it can actually detect things other than prostate cancer as well, and it may lead men who didn’t necessarily need treatment to undergo harmful therapies.

“The problem with PSA testing is that it’s not totally specific for prostate cancer,” Dr James Brooks, a urologic oncologist at Stanford Hospital & Clinics, told SurvivorNet in a previous interview. “It can also reflect enlargement of the prostate, which men get at some point in their lifetime. It can be a product of infection or inflammation. If a man has an elevated PSA, he has somewhere around a 20 to 40% chance of having prostate cancer.”

Issues related to the test include subjecting men to biopsies when they don’t necessarily need them, over-diagnosing men — and recommending treatment for men who are more likely to die of something else instead of a “watch and wait,” active surveillance approach.

Making Informed Screening Decisions

The guidelines saying men between the ages of 55 and 69 should be given the option to decide whether they want to screen for prostate cancer don’t apply to everybody. Some men have a higher risk of developing the disease and should absolutely get regular screening; oftentimes, that means beginning to screen before age 55. Things like family history and ethnicity (black men are significantly more likely to get prostate cancer, for example) can play a role in a man’s risk-level.

Top urologic oncologists explain why some men may be at a higher risk of developing prostate cancer, and why the PSA test in helpful in these situations. 
“Men who are at high-risk because of a family history should have PSA testing earlier,” Dr. David Wise, a medical oncologist at NYU Perlmutter Cancer Center, told SurvivorNet in a previous interview. “At [the] latest, age 40 — but probably even by age 35, they should have an initial PSA. That PSA test at a younger age is a more accurate test because the prostate has not increased in size, which can cause the test to be more difficult to interpret.”

Learn more about SurvivorNet's rigorous medical review process.