Dr. David Samadi on the importance of baseline PSA testing starting at age 40

Each year, September is the month designated as National Prostate Cancer Awareness month, reminding men and their loved ones the importance of early detection and screening for the second leading cause of cancer in men.  The best method detecting prostate cancer, catching it at as early of a stage as possible, is a baseline prostate specific antigen test or PSA beginning at age 40.

Difference of opinions

Even though the United States Preventive Service Task Force (USPSTF) in 2012 advocated against urologists from using the Prostate Specific Antigen (PSA) test to screen men of any age for prostate cancer, I advise against that. Their argument was that the benefits of PSA testing in men may not justify the cost of implementing PSA as a screening tool and there were concerns of the harms of PSA outweighing the benefits.  They stated that the PSA exam and additional treatments that may follow, like radiation and surgery, result in far more harm than benefit.  However, the PSA is an excellent diagnostic tool that can find prostate cancer in men in their 40’s when it is often more aggressive.

What is a PSA test?

The PSA test is a simple blood test that measures the amount of prostate specific antigen present in the blood as is used to screen for prostate cancer.  PSA is a protein that men have in their blood which is released by the prostate gland.  In healthy men, the amount of PSA is low – generally less than 4.0 ng/ml.  However, as men age, their prostate can experience physiological or pathological changes which cause the PSA to rise.

Research findings

In 2016, I published a study in the journal of Urologic Oncology comparing 2,495 of my patients with prostate cancer who underwent SMART prostate cancer surgery.  SMART is a minimally invasive, robot-assisted procedure I have used in my practice for many years. 

The results showed that younger men when compared to older men with similar demographic, clinical, and pathologic function had surgical recovery that was statistically superior to the older men.  Post-surgery 12 months later, 94 percent of the young men and 83 percent of older men had normal sexual function.  When looking at urinary continence 12 months later, results were even better with 96 percent of young men and 94 percent of older achieving normal functioning.  These findings demonstrate that young men below the age of 50 should be screened for prostate cancer as their treatment and surgical outcomes are more favorable at a younger age. After the age of 50 a man’s risk for prostate cancer greatly increases. However, men as young as 40 can get prostate cancer and it is often more aggressive.  With the current technology we have in robotic surgery, this can be a literal lifesaver for many men who have a prostate cancer diagnosis.

Other findings from the study also revealed that waiting until screening a man’s PSA until the age of 50 or older, can result in missing an early diagnosis in up to 11% of patients who have the disease.  Approximately 271 men from the study were found to have significant prostate cancer at the mean age of 46. 

When there is a delay in diagnosing prostate cancer, this only leads to an advanced stage of the disease when it finally is discovered where it may have already metastasized complicating treatment and the outcome.

In conclusion

It is in my professional opinion and from my experience as a urologist that I recommend all men starting at age 40, choose to be screened for prostate cancer by having a PSA test.  It is a prudent step in the right direction in not only detecting early prostate cancer but also for having a baseline level for comparison with future PSA tests.  The earlier prostate cancer can be diagnosed and treated, the greater likelihood of becoming cancer free.