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Prostate-specific antigen (PSA) testing has long been a subject of medical debate. A simple blood test designed to detect early signs of prostate cancer, PSA screening measures the level of PSA, a protein produced by the prostate gland. While elevated levels may suggest cancer, they can also result from benign conditions like prostatitis or an enlarged prostate. Given this ambiguity, the question remains: Should men undergo routine PSA testing?

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The Case For PSA Testing

Prostate cancer is the second most common cancer among men globally. Early detection is key to successful treatment. PSA testing can identify cancer before symptoms appear, potentially catching aggressive forms of the disease at an early, more treatable stage. For men with a family history of prostate cancer or those of African descent—who face higher risks—the PSA test can offer life-saving early warnings.

Supporters argue that when combined with a digital rectal exam and followed by a biopsy if needed, PSA screening can help reduce prostate cancer mortality. Some studies, including European trials, have shown that routine screening may lower the risk of death from prostate cancer by up to 20%. For men who prioritize early detection and peace of mind, PSA testing can be a valuable tool.

The Case Against PSA Testing

Despite its benefits, PSA testing is far from perfect. Elevated PSA levels do not always indicate cancer, and many prostate cancers are slow-growing and non-lethal. This leads to a major concern: overdiagnosis and overtreatment.

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Treatments like surgery or radiation can result in significant side effects, including incontinence and sexual dysfunction. In many cases, these treatments may not be necessary, especially for men with low-risk tumors that are unlikely to affect their lifespan. Critics argue that PSA testing leads to unnecessary biopsies, anxiety, and potentially harmful interventions.

The U.S. Preventive Services Task Force (USPSTF) in 2018 recommends that men aged 55 to 69 make individualized decisions about PSA screening in consultation with their healthcare provider. For men 70 and older, the USPSTF advises against routine screening, citing limited benefits and increased risks of harm.

Making an Informed Decision

The PSA debate highlights the need for personalized care. Men considering the test should weigh their risk factors, personal values, and overall health. A discussion with a trusted doctor can help clarify whether the potential benefits of early detection outweigh the risks of false positives and overtreatment.

Shared decision-making is crucial. For some, the reassurance of regular monitoring provides comfort. For others, avoiding the stress of uncertain results and invasive procedures is the better choice.

Conclusion

There is no one-size-fits-all answer to the PSA question. While the test can help detect prostate cancer early, it also carries the risk of leading to unnecessary treatment. As with many aspects of health care, the best approach is an informed, individualized one—balancing science, statistics, and personal priorities. If you’re a man over 50, or younger with risk factors, talk to your doctor. Together, you can decide if PSA testing is right for you.

This article has been fact-checked by Dr Chong Kian Tai, urologist at Surgi-TEN Specialists, Farrer Park Hospital, Singapore.

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