Should I Have a PSA Test?
“Finding clearly defined screening recommendations for prostate cancer has become more challenging,” says Robert Mordkin, MD, FACS, VHC Physician Group–Urology.
Dr. Mordkin follows the guidelines of the American Urological Association, which advise having PSA testing and a rectal exam every other year starting at age 55 for men at average risk. Men with a family history of prostate cancer are above average risk, and should begin screening starting at age 40. African American men are statistically at higher risk for more aggressive prostate cancer disease, and should consider starting baseline testing earlier. Men over 70 years of age do not need to be screened.
Screening for prostate cancer has gone beyond the traditional mainstays of annual PSA testing and rectal exams. “We evaluate the 4K score—a blood test that includes PSA levels, but also measures a genetic expression that can stratify risk for prostate cancer,” says Dr. Mordkin. “In addition, we have moved away from doing prostate biopsies as an immediate procedure for men who have a one-time elevated PSA. We evaluate trends in PSA levels and use MRI scans to look at prostate tissue to avoid the need for a biopsy.”
“I can’t over-emphasize the importance of having a relationship with a doctor who will walk you through abnormal test results and review the pros and cons of treatment. Many men diagnosed with prostate cancer do not require treatment because it is so slow growing. Instead, we do active surveillance to ensure the cancer does not become aggressive,” says Dr. Mordkin. “With each patient I know how I’m going to manage his disease and guide him through a shared decision-making process. Having a relationship with a physician who has a lot of experience in these areas is the best recommendation
I can make.”