Prostate Test Can't Gauge Full Range of Cancers

Q:  Since 1995, I have gone to a urologist 19 times because my PSA (prostate cancer screening test) was high. It has varied from 5.8 to 8.4.

A biopsy in 1995 was normal, and prostate checks are also normal. I am 77 years old and I read that if a prostate cancer is detected, it would take 20 years to die from it.

I am now thinking of opting out of any further testing. What do you think?

A:  Unfortunately, the PSA (prostate specific antigen) test is imperfect: It does not pick up all prostate cancers, nor does an abnormal test always predict prostate cancer.

You have outlined a common dilemma: It seems like your prostate is benign (not cancer) because your biopsy was normal, your checks are normal, and the level hasn't changed much over 10 years.

And yet, the test is still abnormal and may indicate a slowly growing cancer somewhere in the prostate. What to do?

You are right that some prostate cancers would take 20 years to kill a person, but some take much shorter.

If you are a healthy 77-year-old male, you could be expected to live another 10 years: that may be enough time for a prostate cancer to give you trouble.

Alas, at this point, medical science has not advanced enough to predict reliably which person with an elevated PSA will have a fast-growing cancer and which a slow-growing one.

I shared your story with a colleague, physician Monica Ziebert, an Assistant Professor of Internal Medicine at the Medical College of Wisconsin with expertise in prevention and geriatrics. (Dr. Ziebert practices at the Froedtert & The Medical College of Wisconsin General Internal Medicine Clinic - East.)

She agrees that ceasing PSA testing is a reasonable option and a good choice for someone like you who understands the complexities of the situation.

Your risk of important prostate cancer is low, while the burden of doctor visits and the questions they bring is weighing on you.

If you talk it over with your primary care provider, he or she may be able to give you even more individual advice, knowing you and your medical history better.

For more information on this topic, see the HealthLink article Prostate Cancer Surgery: Weighing the Risks and Benefits.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices at the Froedtert & The Medical College of Wisconsin General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.