Prostate Cancer Prevention: The PSA Blood Test

Background

In our busy lives it’s easy to lose track of time.  I’ve had male patients who have told me “I have not had any blood work in 10 or more years”.  Some are scared to have blood tests as they don’t want to discover something is wrong, or have had good health and no reason to have blood tests. One of the blood tests that men in my practice avoid having, or when to have is the PSA blood test for prostate cancer screening.

What is the PSA blood test?

• Prostate-specific antigen (PSA) is a protein produced by normal prostate cells. The highest amounts of PSA are found in the seminal fluid; some PSA escapes the prostate and can be found in the serum. The serum component is of clinical interest as it provides information about some conditions that can affect the prostate. 
• Prostate infection (prostatitis), prostate enlargement and prostate cancer can all increase the levels of PSA in the blood.

When should a male start to have a blood test to screen for prostate cancer? 

Since 2014, there has been some controversy with respect screening for prostate cancer. The Canadian Task Force on Preventive Health Care put out a position on PSA screening that recommended men under 55 should not be screened for prostate cancer.  However, the Canadian Urological Association had evidence towards starting PSA testing at 50 years of age (PMID: 29381452).

The cost of doing millions of PSA blood tests is expensive and may not affect the overall mortality rate from prostate cancer if done too early. So, the risk/benefit of having the PSA blood test by some authorities leans towards later screening.  After reading all sides of the scientific story, there is one major factor that changes when I check PSA levels with patients in my practice – family history.

Family history and prostate cancer

In my practice, the major factor that changes the age for screening for prostate cancer is when a male patient meets the criteria for Hereditary Prostate Cancer (HPC).

HPC is presently defined by any one of the following three criteria:

• Three successive generations with members having Prostate Cancer.
• Three first-degree relatives, for example, a father and two brothers, three brothers, or a father and two sons with PC.
• Two relatives with PC diagnosed before age 55.

When HPC is present the risk of getting prostate cancer earlier in life increases and some cases develop before the age of 55. These cases are often more serious and require more immediate medical intervention.  If someone is adopted or does not know their family history, this is also a red flag to order the PSA test before the age of 55, given the uncertainty about the individual’s family history in relation to prostate cancer.

Final thoughts

Naturopathic Doctors in Ontario are able to requisition lab tests. I focus on an individualized monitoring plan and screening plan. My suggestion is to start screening at age 45 for men who meet the criteria for hereditary prostate cancer and for those who do not know their family history or are adopted with lower urinary tract symptoms as part of their screening.  All others start at 50 years of age.  Depending on the results, follow-up screening is then once again determined on a case-by-case basis.

Statistics for a “one size fits all” model may be of value economically; however, I think each patient needs an individualized approach for treatment, lab tests and monitoring.  If you are a male who is avoiding getting screened for prostate cancer, please go and talk to your health care provider and discuss the best approach for you.