PSA test guidelines have changed over the years

Dear Doctors: If my doctor won’t order a PSA or other screening test, can I pay for it myself? We are always told about the importance of early detection. So why aren’t screening tests recommended for seniors? I get a more comprehensive overview of my car’s health when I get an oil change!

Dear Reader: A screening test is used to determine if someone who is asymptomatic has developed a disease or condition. The intent is to identify a medical issue at an early stage, when treatment is more likely to result in a positive outcome. This may be curing the disease or managing it to improve longevity and quality of life.

Health data show that these types of screenings can save and extend lives. But it’s important to note that the guidelines for these tests are only that — guidelines. They are not hard and fast rules. Rather, they are recommendations based on the analysis of a complex range of scientific data.

How, when and by whom a screening test is used depends on each individual person. The decision takes into account someone’s general health, their medical and family histories and age. It also includes the determination of whether the test itself may lead to potential harm. This includes stress and worry, physical harm, inaccurate results and unneeded follow-up tests or procedures.

Older adults are often living with health conditions that make treating a disease, such as cancer, its own health risk. When this is the case, certain types of screening tests are recommended only when the potential benefits outweigh the potential harms.

The prostate-specific antigen (PSA) test you mention falls into that category. While effective at detecting certain hormonal changes that occur when someone has prostate cancer, it can return false positive results. The PSA test has been overused in the past, which has led to unnecessary, and possibly harmful, treatment.

The current recommendation for men between the ages of 55 and 69 is to decide on the use of a PSA test on a case-by-case basis. That means evaluating someone’s general health, their risk for prostate cancer and their ability to move forward with further testing and treatment if needed. Here at UCLA, for example, we recommend that Black men of all ages, who are at increased risk of developing prostate cancer, work with their doctors to tailor PSA testing to their unique and specific needs.

When working with our own patients, we have in-depth discussions about the potential risks of the test versus the possible benefits. We view our relationships with our patients as a coaching partnership rather than a paternalistic one. We believe strongly in shared decision-making. Some patients, after learning the risks, decline the test. Others enthusiastically accept it.

It is possible to find a lab where you can order your own PSA test. However, we think your energies are better spent looking for a different doctor. Find someone who is willing to let you share in these important health care decisions. That you feel your mechanic offers better care than your current doctor says a lot about that relationship. We think you can find a better match.

(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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