PSA Quiz
Male celebrities are encouraging all men over fifty to get a PSA blood test for early detection of prostate cancer. But many doctors believe that this message is not supported by medical evidence. Take our quiz to help you decide if PSA screening is right for you.
1. A PSA level above the normal of 4 nanograms per milliliter means that you have prostate cancer.
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Most men with PSA levels greater than 4 do not have prostate cancer. If your doctor does not feel any prostate irregularities on rectal examination, the risk of prostate cancer is less than one in three. Reasons for an elevated PSA other than cancer include benign prostatic hyperplasia (an enlarged prostate gland), sexual intercourse or ejaculation in the 48 hours before the blood test was drawn, a prostate or bladder infection, a long bike ride, and placement of a urinary catheter.
2. A PSA level under 4 nanograms per milliliter means that you do not have prostate cancer.
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A study published in the May 27, 2004 issue of the New England Journal of Medicine found that 15 percent of men ages 62 to 91 with PSA values of less than 4 had biopsy-proven prostate cancer, and some had very low PSA levels.
3. African-American men have a greater risk of dying from prostate cancer than most other racial groups.
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Compared to white men, African-American men are one and one-half times more likely to develop prostate cancer and are two to three times more likely to die from the cancer. Many experts suggest that African-American men begin screening for prostate cancer at age 40 to 45 with yearly digital rectal examination and a PSA blood test.
4. Younger men generally have higher PSA levels than older men.
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Older men have higher PSA levels than younger men. In the absence of prostate cancer, infection or other irritation of the gland, PSA levels increase by about 0.5 nanograms per milliliter every 10 years. The rise is very gradual. A more sudden increase in PSA level from one year to the next may indicate a problem.
5. Most men will develop prostate cancer if they live to age 100.
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Actually almost every man who lives to age 100 has prostate cancer, but the chance that a very old man will die of the disease is very slim. Autopsy studies show that approximately 40 percent of men over age 70, 70 percent of men over age 80, and over 95 percent of men over age 90 have cancer cells in their prostates.
6. The PSA level reliably predicts who can be cured with prostate surgery (called radical prostatectomy).
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Although the higher the PSA level, the greater the chance that the prostate cancer has spread outside the gland, the PSA level cannot predict which individuals should be treated and what will be the optimal treatment. In fact, some very aggressive prostate cancers that have a poor prognosis produce little PSA. Prostate cancer treatment is based on the symptoms, the analysis of the prostate biopsy and staging (to determine the extent of cancer).
7. Treatment of prostate cancer with radiation carries little risk of side effects.
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Radiation therapy, either by external beam or with implanted radioactive seeds (called brachytherapy), is used most often when the cancer remains confined within the gland. Incontinence and erectile dysfunction can occur after radiation therapy, but perhaps less often compared to radical prostatectomy. Prostate radiation can sometimes cause irritation of the bladder or rectum. This may result in frequent urination or diarrhea and bleeding.
8. A rising PSA year over year may be a better marker for prostate cancer than a number over 4 that is not rising.
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This is called the PSA velocity and is a measure of how rapidly PSA levels are rising over time. Men with benign enlarged prostates (benign prostatic hyperplasia, or BPH), show very minimal increases in PSA levels from one year to the next. A PSA level that increases quickly from one test to the next suggests either irritation of the prostate or prostate cancer.
9. If your brother has prostate cancer, your risk of developing it is three times greater than the average.
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Family history of prostate cancer, especially prostate cancer in a first-degree relative, increases your personal risk of developing the disease. Of all your relatives, a brother with prostate cancer increases your risk the most. If you have a brother with prostate cancer, you should discuss when to start screening for prostate cancer with your doctor.
10. Men fear colon cancer more than prostate cancer.
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A survey from the Harvard Risk Management Foundation found that, on a scale of men's cancer fears, prostate cancer ranked number one. Colon cancer ranked number seven, behind a variety of less common diseases. Both cancers kill almost 30,000 men per year. While colon cancer screening clearly decreases the cancer death rate, it is controversial as to whether PSA testing reduces prostate cancer death rate.
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