PSA tests are easy and cheap enough that any concerning single result should be followed up with several more to see if there's an increasing / accelerating trend. An elevated but flat trend could be BPH, and as others have mentioned, a single elevated result can be caused by many things (prostatitis, etc).
The recommendation to not do widespread PSA testing is extremely controversial. Also, as an individual, you should make decisions for yourself, not based on some population-wide study.
I think you should always do regular PSA testing, but don't automatically follow it up with a biopsy if it's not that high (just slightly elevated). Instead, do a second-line test like a 4Kscore test, and/or look at your PSA velocity, or look at PHI (Prostate Health Index) scores. Basically, the assumption that "anything over a certain cutoff should be biopsied" is dumb and they should actually just do second-line tests before biopsies, for borderline scores.
There are conflicting studies. This is common. It's tough to put together randomized trials over a multi-decade period to get the highest quality data. But among oncologists there is very widespread agreement on the benefits of PSA testing.
I agree to with the other reply to my comment that stated "Also, as an individual, you should make decisions for yourself, not based on some population-wide study."
That is, the tough problem for scientific recommendations like PSA screenings is they essentially need to apply to everyone, and "everyone" has to take into account that most people don't understand how to quantify risk and they usually see things in terms of black-and-white.
That said, I don't think the statement "But among oncologists there is very widespread agreement on the benefits of PSA testing." accounts much for anything. There have been loads of examples of highly trained specialists in the past recommending something based more on "well, logically it makes sense", only to not see it actually play out when studied more closely. I find this especially true that there is a general bias among all specialist professions (not just medicine) to "do something", when sometimes the best thing is to just do nothing.
Sure but we should still listen to specialists. They aren’t always right but they are wrong less often than the rest of us.
As for “doing something” actually there has been a consistent trend in the prostate cancer fields towards doing less. As the years go by they get better quality data from long term studies supporting “watchful waiting” for many lower grade cancers. I even had a more aggressive one and they let me go several years before surgery, just to maximize quality of life. That’s all due to new data. Data that definitely one needs specialist skills to interpret.
There is no single threshold above which you’d say it’s cancer.
PSA levels will vary between people, basically depending on the size of the individual prostate and physical activity (they should not take your PSA when you took your cycle to go to the doctor).
Which is why the best course of action is to get a series of (yearly) PSA values starting from you (mid-) forties. Such that you have established your personal baseline and can easily spot a significant uptick.
Yes but it is still an excellent first-level screening tool. A few things can cause elevated PSA. Typically you will get retested a bunch of times to see if it comes back down to normal levels. But if it stays up you may be a good candidate for an MRI-guided biopsy to look for tumors.
