Last of three parts

Cancer of the prostate is one of the most common types of cancer among American men.

Prostate-Specific Antigen (PSA) is a protein produced by the cells of the prostate gland.

The PSA test measures the level of this protein in the blood. It can be detected at a low level in the blood of all adult men.

A fundamental problem with the PSA test is that, while elevated levels can indicate the presence of cancer, they can also be caused by other benign problems such as infection.

PSA test results are horribly confusing and often terrifying.

In this column, we’ll address the primary question about PSA: Does it save lives?

The answer is: We don’t know.

What’s worse is that we don’t know if PSA screening outweighs the risks of follow-up diagnostic tests and cancer treatments.

For example, prostate surgery can cause incontinence and erectile dysfunction. Even a prostate biopsy has risks because it can cause bleeding and infection.

The PSA test can detect small tumors. However, finding a small tumor does not necessarily reduce a man’s chance of dying from prostate cancer.

PSA testing may identify very slow-growing tumors that are unlikely to threaten a man’s life.

Also, PSA testing may not help a man with a fast-growing or aggressive cancer that has already spread to other parts of his body before being detected.

So, what should a man do to protect himself from prostate cancer?

Some doctors encourage annual screenings for men older than age 50; others recommend against routine screening.

However, most doctors and medical organizations agree that men should learn all they can about prostate cancer, so they can make intelligent decisions.

The American Cancer Society (ACS) recommends that men make an informed decision with their healthcare providers about whether to be screened for prostate cancer using a PSA blood test.

Rather than advising routine screening for everyone, ACS emphasizes discussing the potential benefits, risks and limitations of testing first.

ACS guidelines state that men who do not have symptoms and have less than a 10-year life expectancy should not be offered prostate cancer screening, because the risks of over-diagnosis and treatment side effects generally outweigh the potential benefits.

My personal history with PSA tests is illustrative of many of the problems men face with this type of screening.

When I was young man, my PSA was always around 1.5 when most doctors want your PSA to be under 4. (The numbers stand for nanograms of PSA per milliliter of blood.) And, my Digital Rectal Exams (DRE) found no irregularities.

One year, my family physician gave me a DRE and found nothing, but my PSA test came in at 2.97. My doctor told me to see a urologist for a follow-up exam because my PSA, while under 4, had increased.

The urologist did another DRE and ordered another PSA test. The test came in at 2.96. The urologist said that he thought 2.96 was my new PSA and that I should not worry about it.

Two years later, my PSA was still 2.96. Then, the following year, it came in at 4.1. My family physician sent me to a urologist.

Before I went to the urologist, I did some research and learned that something as seemingly insignificant as a bowel movement could affect a PSA test.

I told the urologist that I recalled going to the bathroom just before having blood drawn. He thought that the BM could have affected the test.

Another DRE. OK. Another blood test. The PSA was 3.3. The urologist said no biopsy was required. The increase from 2.96 to 3.3 was not a cause for concern.

As I aged, my benign prostate continued to grow and my PSA increased. At one point in my 70s, the PSA jumped to 7.4. This resulted in a hospitalization for a biopsy that was negative.

After this jump, my PSA began dropping and has settled at 5. I’m in my 80s now and will not need another PSA test. Whew!

Have a question? Email: fred@healthygeezer.com. Order “How To Be A Healthy Geezer,” 218-page compilation of columns: healthygeezer.com

All Rights Reserved © 2026 Fred Cicetti

The Times News, Inc. and affiliates (Lehigh Valley Press) do not endorse or recommend any medical products, processes, or services or provide medical advice. The views of the columnist and column do not necessarily state or reflect those of the Lehigh Valley Press. The article content is not intended as a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician, or other qualified health-care provider, with any questions you may have regarding a medical condition.