Recent attention to former President Joe Biden’s prostate cancer diagnosis has reignited debate around PSA testing — a common blood test used to screen for prostate cancer, the most frequently diagnosed cancer among American men.
While the prostate-specific antigen (PSA) test has helped detect many life-threatening cancers early, physicians caution that the test is imperfect and can lead to unnecessary biopsies, overdiagnosis, and harmful side effects in men with low-risk or non-aggressive cancers.
What the PSA Test Actually Measures
The PSA test measures levels of a protein made by both normal and cancerous prostate cells. High PSA levels can indicate prostate cancer — but they can also result from other benign conditions like inflammation or an enlarged prostate.
That ambiguity has led to years of conflicting recommendations, as public health experts have tried to balance early cancer detection against the risks of over-treatment.
“PSA screening is beneficial,” said Dr. Brent Rose, a radiation oncologist at UC San Diego. “But there are risks, and it’s a personal decision whether to do it.”
The Problem: Treating Too Much, Too Early
Part of the challenge is avoiding aggressive treatment for slow-growing tumors that may never cause harm.
Autopsy studies show that over one-third of white men and half of Black men in their 70s may have prostate cancer that never showed symptoms in their lifetime.
Yet once a PSA test flags elevated levels, the next step often involves a biopsy and potentially treatment with significant side effects:
- Erectile dysfunction
- Urinary incontinence
- Bowel damage
Doctors now emphasize targeting only aggressive cancers, while carefully monitoring others through “active surveillance.”
Shifting Medical Guidance Over Time
The U.S. Preventive Services Task Force (USPSTF) — a leading authority on screening — has changed its recommendations several times:
- 2008: Recommended no PSA screening for men over 75
- 2012: Advised against screening altogether
- 2018: Softened its stance, saying men ages 55 to 69 should make individualized decisions with their doctors (Grade C recommendation)
- Still advises against screening for men 70 and older
Biden, 82, reportedly followed that guidance, having last received a PSA test in 2014.
Who Should Consider PSA Testing?
Experts agree PSA testing makes the most sense for:
- Men 55–69 willing to discuss trade-offs with a provider
- Men at higher risk:
- Black men
- Those with a family history of prostate cancer
- Men with a history of elevated PSA levels
Still, many men avoid the test due to fear of cancer, anxiety over test results, or confusion over shifting medical advice.
The Case in Favor of More Screening
Dr. Alicia Morgans, a genitourinary oncologist at Dana-Farber Cancer Institute and chair of Zero Prostate Cancer’s advisory board, supports more widespread screening, especially among vulnerable groups.
She argues that past clinical trials underestimated PSA’s benefit because control groups often received PSA tests anyway, muddying results.
“I want to make the diagnosis when cancer is curable,” she said.
Urologist Dr. Matthew Cooperberg believes rebranding low-risk prostate cancer as something less alarming — such as “acinar neoplasm” — could reduce unnecessary panic while still allowing careful monitoring.
A New Approach: MRI Before Biopsy
Radiation oncologist Dr. Tyler Seibert supports the emerging strategy of ordering an MRI before jumping to biopsy after a high PSA reading. This step helps identify truly dangerous cancers, reducing unnecessary procedures.
“Many prostate cancers never would have harmed the patient,” Seibert said.
Men with low-risk diagnoses are now frequently advised to follow a “watch-and-wait” protocol, returning regularly for PSA checks without rushing into treatment.
Should You Get Tested?
Ultimately, the decision to screen remains personal and nuanced. For men in their 50s and 60s — especially those at higher risk — PSA testing may provide valuable early warning. But it also demands clear communication with providers and an understanding of what a high PSA level may or may not mean.
Doctors recommend patients weigh:
- Personal risk factors
- Comfort with uncertainty and surveillance
- Willingness to discuss options if the test comes back elevated
“Every time you get that blood test, you’re a little bit nervous,” Seibert said. “But if you can live with that, screening may make sense.”
Have you or a loved one faced the decision of whether to screen for prostate cancer?
Share your experience in the comments.
Sources
- USPSTF Prostate Screening Recommendation: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening
- AUA Prostate Health Resource Center: https://www.auanet.org/education/patient-education
- Cancer.gov PSA Overview: https://www.cancer.gov/types/prostate/psa-fact-sheet
