Former President Joseph Biden’s advanced prostate cancer diagnosis has reignited long-standing debates about the PSA (prostate-specific antigen) blood test, a screening tool for the most commonly diagnosed cancer in U.S. men.
While PSA tests can detect aggressive tumors, they also pose risks of overdiagnosis and overtreatment, according to doctors and public health experts.
PSA screening measures blood levels of a protein produced by both normal and cancerous prostate cells. Elevated PSA levels may signal cancer, but they can also trigger false positives or unnecessary biopsies.
Autopsy studies show over a third of white men and half of Black men in their 70s have prostate cancers that never cause harm. “PSA testing alone is an imperfect screening tool,” says radiation oncologist Dr. Brent Rose of UC San Diego. “It has benefits, but also risks—screening is a personal decision.”
For decades, public health guidelines on PSA screening have fluctuated. The U.S. Preventive Services Task Force (USPSTF) initially advised against screening in 2012, then revised its stance in 2018 to recommend 55-69-year-olds discuss screening with doctors. Men over 70 are still discouraged from screening. Biden, 82, last had a PSA test in 2014 at age 71-72, aligning with these guidelines.
Experts now push for more targeted approaches. Dr. Alicia Morgans of Dana-Farber Cancer Institute argues current guidelines rely on flawed trials where nearly 90% of control-group men received PSA tests.
She advocates earlier screening for Black men and those with family history. Dr. Matthew Cooperberg of UC San Francisco suggests renaming low-risk prostate growths to reduce stigma and promoting “active surveillance” over immediate biopsies for elevated PSA levels.
A growing number of specialists now recommend MRI scans before biopsies for elevated PSA results. “For low-risk cases, close monitoring allows patients to live normally,” says Dr. Tyler Seibert of UC San Diego. While periodic testing can cause anxiety, most patients adapt to the protocol.
Life Tips for Men:
Ages 55-69: Discuss screening with your doctor, considering family history and race (Black men face higher risks).
Over 70: Skip routine PSA tests unless high-risk.
Elevated PSA? Start with an MRI before biopsy; low-risk tumors may only need monitoring.
The PSA screening debate highlights medicine’s challenge: balancing early detection with avoiding harm from overtreatment. For men, personalized conversations with healthcare providers remain key to navigating these complex decisions.
Related topics:
- Last Prostate Cancer Test for Biden Was Over a Decade Ago
- Blood Test May Predict Prostate Cancer Treatment Failure, Study Finds
- PSA Test: A Key Tool For Monitoring Prostate Cancer Recurrence
