There is no such thing as a normal PSA test, according to Dr. Ian Thompson, chief of Urology at UT Health Sciences Center in San Antonio. He reported in a paper in the New England Journal of Medicine that biopsies found cancers in 15% of men whose PSA had been below 4, which is considered within the normal range.
In a paper in the Journal of Urology, Dr. Thomas Stamey of Stanford said that the PSA test is 'virtually useless.' When the PSA level is between 2 and 10, it is usually caused by a harmless enlargement of the prostate, found in most middle aged men.
The problem is that the PSA test gives many false positive tests (diagnosing cancer when there is none) and also many false negative results (not diagnosing cancer when it is there).
Just last month, Dr. Peter Albertsen of the University of Connecticut Health Center published a study in the Journal of the American Medical Association. He claims that the microscope can tell who needs to be treated and who doesn't. If a biopsy of the prostate gland shows cancer isn't an aggressive type, then, according to Albertsen, watchful waiting is the best treatment.
In this case, most men can do very well with no treatment for at least 20 years. This is due to the fact that only a small percentage of prostate cancers are dangerous. Dr. Timothy Wilt of the V.A. Center in Minneapolis says that most men will eventually develop prostate cancer but they will die of something else, many without ever knowing they ever had cancer.
What, then, should a man do? The first thing is to know your risk factors. If you are African-American, have a family history of prostate cancer or are fat, the doctor may want to be more careful following you. Blacks tend to develop more aggressive cancer and it appears at an earlier age.
A recent article in the New York Times called this dilemma one of the great issues in medicine today. There is not a test which will tell a doctor how to proceed. This also makes treatment decisions harder for both the patient and the doctor.
In the meantime, it would appear it is wise to have an exam by your doctor every year after the age of 50 and a PSA test (earlier for those at high risk). Just remember that most men with an elevated PSA do not have cancer. Ongoing research should give us more definitive guidelines about 2010.