What are Some of the Problems with the PSA Test?

Problems with the PSA test have been causing controversy due to the many false positive or false negative results of the blood test.

In cases in which the test result is a false positive, the PSA is elevated but there is no sign of cancer. Why is this harmful?  The US Preventive Service Task Force (USPSTF) found that nearly 80% of positive PSA screenings were false, leading to psychological harm, anxiety, and unnecessary biopsies. There are risks associated with a biopsy, including bleeding, pain, infection, temporary urinary difficulties, and others including hospitalization.

False negatives can be harmful as well because the PSA may be low even though the patient actually has prostate cancer. The results may not alert the man and his doctor that he does in fact have cancer and that he needs treatment. The unreliability of the PSA is the main reason for the controversy over problems with the PSA test.

Facts about problems with the PSA test:

  • It can give false positives or false negatives (indicating you may have cancer when you don’t or indicating you do not have any cancer when you do)
  • A high PSA level is commonly associated with benign conditions such as prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH), which is enlargement of the prostate.
  • Other conditions can temporarily affect PSA levels such as catheterization and ejaculation as well as some other activities that can boost PSA levels.
  • PSA test results cannot tell you if the cancer is slow to develop or life threatening.

Statements about problems with the PSA test

In May 2012, USPSTF Co-Chair Michael LeFevre, M.D., M.S.P.H., made the following statement about the PSA test, “Prostate cancer is a serious health problem that affects thousands of men and their families. But before getting a PSA test, all men deserve to know what the science tells us about PSA screening: there is a very small potential benefit and significant potential harms. We encourage clinicians to consider this evidence and not screen their patients with a PSA test unless the individual being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risk of harms.”

The USPSTF assessed the possible benefits and harms of PSA screening for men aged 55-69 who are screened with a PSA test every 1 to 4 years for 10 years. They report that a U.S. study found no benefit to screening and that a large European study found at most 1 man in 1,000 avoids death from prostate cancer due to screening. Among the harms found by the USPSTF, for every 1,000 men screened:

  • 30 to 40 men will develop erectile dysfunction or urinary incontinence due to treatment
  • 2 men will have a cardiac event such as a heart attack, due to treatment
  • 1 man will get a blood clot in his leg or lung due to treatment

Talk to your doctor to find out if you are in a high-risk group or to find out if getting a PSA test is beneficial for you. Both the USPSTF and the American Urological Association (AUA) have recently changed their guidelines on who should get tested and how frequently based on the problems with the PSA test.

Read more in our Prostate Cancer Health Center.