The pros and cons of PSA tests for prostate cancer for midlife and older men

By Ronnie Cohen

News that former President Joseph Biden has advanced prostate cancer has revived long-standing questions about the benefits versus the harms of a blood test that screens for the most commonly diagnosed cancer among men in the U.S.

Prostate-specific antigen, or PSA, screening tests are an imperfect tool for detecting prostate cancer, doctors and public health experts say.

Part of the problem is identifying and treating aggressive cancers like Biden's while not unnecessarily treating men with slow-growing cancers unlikely to sicken them. Autopsies found the disease to be so widespread that more than one-third of white men and half of Black men in their 70s had prostate cancers that would never do any harm.

"PSA testing alone leaves a lot to be desired as a cancer screening test," said radiation oncologist Dr. Brent Rose, an associate professor at the University of California, San Diego, School of Medicine.

The test measures the level of PSA, a protein produced by normal as well as malignant prostate gland cells, in the blood. Elevated PSA can be a marker for cancer. It also can signal a false positive or an inactive cancer, triggering a painful biopsy, and leading to overtreatment with punishing side effects, including impotence, incontinence and bowel dysfunction.

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