Some men get a break on the PSA test

The PSA test is designed to do two things: 1) screen men for prostate cancer, and 2) drive men up the wall with anxiety. That's because it's an imprecise test that can lead to biopsies that aren't needed and surgeries that don't prolong life, but do make it miserable.

Now comes some hope for some men. A blood test at the age of 60 can accurately predict the risk that a man will die from prostate cancer within the next 25 years, according to researchers at Memorial Sloan-Kettering Cancer Center, in New York, and Lund University, in Sweden. This could have important implications for determining which men should be screened after the age of 60 and which may not benefit substantially from continued prostate cancer screening.

Following more than a thousand men, the researchers found:

Men with a PSA level above 2 ng/ml at age 60 should be considered at increased risk of aggressive prostate cancer and should continue to be screened regularly. Men with a PSA level below 1 ng / ml had a 0.2 percent chance of death from prostate cancer. The researchers concluded that men with PSA levels in this range, which is about half of all men, should be considered at low risk of prostate cancer death and may not need to be screened in the future.

In another study, Professor Philipp Dahm and colleagues at the University of Florida reviewed six trials, involving 387,286 participants. They found that PSA screening aids in the diagnosis of prostate cancer at an earlier stage, but does not have a significant impact on mortality, and comes at the risk of over-treatment.

The authors say there is insufficient evidence to support actively inviting all men in certain age groups to attend screening for prostate cancer (as happens with breast cancer screening for women), and they suggest men should be better informed about the uncertainties associated with screening.

What to do? Science Daily quotes Gerald Andriole, Chief of Urologic Surgery at Washington University School of Medicine. He suggests that PSA testing should be tailored to individual risk.

He recommends that young men at high risk of prostate cancer, such as those with a strong family history and higher baseline PSA concentrations, should be followed closely, while elderly men and those with a low risk of disease could be tested less often, if at all. "Approaches such as these will hopefully make the next 20 years of PSA based screening better than the first 20," he says.

You need to have a heart to heart with a doctor you trust, and if you don't like what you hear or feel it is incomplete or that you are being rushed into a decision, get a second opinion. This is one of those conditions that requires the patient to make decisions, and you might as well get educated now, before any alarms go off.