Prostate cancer remains one of the most common cancers among men, and screening for it has long been debated in the medical community. One of the central tools in this discussion is the prostate-specific antigen (PSA) test—a simple blood test that measures levels of PSA, a protein produced by both normal and cancerous prostate cells.
While widely available, PSA testing has sparked ongoing discussion about its benefits and risks. Understanding how the test works, what the results mean, and who should consider screening can help men and their healthcare providers make more informed choices.
How PSA Screening Works
PSA is naturally present in the blood, but higher levels can indicate prostate-related conditions. These include:
- Prostate cancer – Higher PSA levels may reflect cancer growth.
- Benign prostatic hyperplasia (BPH) – Enlargement of the prostate that is not cancerous.
- Prostatitis – Inflammation or infection of the prostate.
- Other temporary changes – Activities such as cycling or sexual activity can also elevate PSA levels.
In general, a PSA value above 4 ng/mL has traditionally been considered “abnormal.” However, thresholds vary by age and clinical context. For example, a PSA level of 3.5 ng/mL might raise concern for a man in his 40s, while a slightly higher reading could be less worrisome for someone in his 60s.
Why PSA Screening Is Controversial
PSA testing became common in the early 1990s, but its use has been debated due to the risk of overdiagnosis. Prostate cancer often grows slowly, and many tumors detected by PSA would not have caused harm during a man’s lifetime. Detecting these cancers can lead to unnecessary biopsies, treatments, and side effects without clear survival benefits.
The U.S. Preventive Services Task Force (USPSTF) currently recommends that men between ages 55–69 discuss PSA screening with their providers to weigh the pros and cons. Routine screening is generally not advised for men over 70, and for men under 55 it is not recommended unless specific risk factors are present.
Who Is at Higher Risk?
Certain groups may benefit from earlier or more frequent PSA testing, including:
- Black men, who face nearly double the risk of prostate cancer diagnosis and mortality compared to white men.
- Men with family history, especially first-degree relatives who had prostate cancer at a young age.
- Men with genetic predispositions, including BRCA1 or BRCA2 mutations.
For these individuals, some organizations, such as the American Cancer Society (ACS), recommend beginning PSA screening around age 45—or earlier in specific high-risk cases.
What Happens After an Abnormal Result?
In the past, elevated PSA levels almost always led to a prostate biopsy. Today, the approach is more nuanced. An abnormal PSA is often followed by:
- MRI scans to identify suspicious regions in the prostate.
- Targeted biopsies of areas highlighted on imaging.
- Active surveillance for low-grade cancers—monitoring with regular PSA tests, imaging, and biopsies instead of immediate treatment.
- Immediate treatment for aggressive, high-grade cancers that pose significant risk.
Additional variations of the PSA test are sometimes used, such as free PSA percentage, PSA density, and PSA velocity, to refine whether cancer risk is present before proceeding with invasive steps.
The Bottom Line
PSA testing is not a one-size-fits-all solution. For some men, it offers the chance to catch cancer early and improve outcomes. For others, it may bring unnecessary interventions. The key is personalized decision-making—considering risk factors, family history, and overall health.
EMMA International’s Perspective
At EMMA International, we understand how evolving diagnostic tools like the PSA test shape patient care and regulatory expectations. Our team helps life science organizations anticipate how emerging research influences guidelines, risk assessments, and long-term product strategies. By combining scientific insight with regulatory expertise, we ensure that innovations in diagnostics and treatments are aligned with both clinical value and compliance requirements.
For more information on how EMMA International can assist, visit www.emmainternational.com. Contact EMMA International at (248) 987-4497 or by email at info@emmainternational.com to learn more.
References
American Cancer Society. (2023). American Cancer Society recommendations for prostate cancer early detection. Retrieved from https://www.cancer.org/cancer/prostate-cancer
U.S. Preventive Services Task Force. (2018). Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA, 319(18), 1901–1913. https://doi.org/10.1001/jama.2018.3710otein biosimilars.
