| Tue, Jun 20, 2017 @ 09:00 AM

Should All Men Have Routine PSA Tests for Prostate Cancer?

Posted by Medicare Made Clear

senior-man-with-son-in-hammockAsk ten doctors about the PSA test, and you might get ten different viewpoints. The test can help detect prostate cancer in men, but opinions vary as to who should have it and when.

Routine prostate cancer screening using the PSA test was introduced in the U.S. around 1990. Since then, medical organizations and government health agencies have gone back and forth from recommending yearly screenings to saying it’s optional to outright discouraging use of the test.1,2

Value versus possible harms   

The unsettled history of the PSA test is due to conflicting research about its value in saving lives versus the harms caused by false positives and overtreatment.3 A false positive shows a possible cancer when none is actually there. The initial positive result and further tests, such as a biopsy, can cause stress, worry and expense. And biopsies themselves may cause problems such as pain, bleeding and infection.

Prostate cancers found by PSA tests are often small, grow slowly and may never cause any real problem if left untreated. Many are treated anyway, however, which may come with more stress, worry and expense – and possibly additional health problems. Treatment for prostate cancer may include radiation or surgery. Side effects such as infections, impotence and incontinence may occur. On the plus side, the 5-year survival rate for local and regional stage prostate cancer is nearly 100%.4

What should you do?

Doctors consult research-based recommendations and their own experience when making clinical decisions. And because medicine is an art as well as a science, both can vary. Often there are no clear answers.

That leaves health care decisions, such as when to have a PSA test, in the hands of doctors and their patients. The best answer for you is the one that you and your doctor arrive at together.

Certain situations increase the risk of developing prostate cancer and might tip the scale toward the benefit side of having regular PSA tests. Talk to your doctor about the impact of these situations on your personal risk and how it should factor into your decision about PSA testing. Situations that may increase your risk include:

  • You are older. About 6 in 10 cases of prostate cancer are found in men older than 65.4
  • You have a family history of prostate cancer. Having a father or brother with prostate cancer more than doubles a man’s risk of developing the disease.4
  • You are African American. Nobody knows why, but prostate cancer occurs more often in African-American men and in Caribbean men of African ancestry than in men of other races.4

The following symptoms may occur with prostate cancer or with other health problems. If you have any of these symptoms, you should talk to your doctor about identifying and treating the cause:

  • Problems urinating
  • Blood in the urine or semen
  • Trouble getting an erection
  • Pain in the hips, back, chest, or other areas
  • Weakness or numbness in the legs or feet

Annual PSA test covered by Medicare

A yearly PSA test is a preventive care benefit provided by Medicare Part B. There is no additional cost for the test if your doctor accepts Medicare assignment. Medicare Advantage plans also cover PSA tests. Check with your plan for details.

The bottom line

You may read or hear conflicting ideas about the PSA test and who should have it. It’s important to understand the pros and cons and to weigh them based on your personal situation and health needs. Your Medicare Wellness Visit is a great time to talk with your doctor about the PSA test. Together, you can decide whether to make it part of your preventive health care plan.

Related articles

Men are Different from Women. So are Their Health Care Needs

5 Reasons Men Skip Doctor Visits, and Shouldn’t

3 Health Concerns Top the List for Older Men

 

For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.

 

Resources

1History of ACS Recommendations for the Early Detection of Cancer in People Without Symptoms

2USPSTF Recommends Against PSA-based Prostate Cancer Screening

3Prostate Cancer (Centers for Disease Control and Prevention)

4Prostate Cancer (American Cancer Society)

 

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