Busting myths and misconceptions about the PSA test

News that former President Joe Biden was diagnosed with an aggressive form of late-stage prostate cancer raised questions in the media and elsewhere about how it was missed and whether testing for the disease is accurate or sufficient.

It also revived some myths and misconceptions about the second most deadly cancer among U.S. men. This misinformation can create confusion, fear and stress for patients and their loved ones, according to UCI Health prostate cancer specialists.

Dr. David I. Lee, director of the UCI Health Comprehensive Prostate Cancer Program, and medical oncologist Dr. Arash Rezazadeh Kalebasty debunk some of those myths and misconceptions surrounding the disease, which is projected to claim nearly 36,000 lives this year.

They include:

• Blood tests for prostate-specific antigen (PSA) are part of a man’s annual physical.
  “Unfortunately, this is false,” says Lee, a urologist who specializes in minimally invasive robot-assisted prostate cancer surgery. “Many primary care providers do not use the PSA to regularly screen their male patients for prostate cancer markers.”
  
  In 2023, only 38% of men between ages 55 and 69 had an annual PSA test, which can catch cancer in its early stages in many cases, according to the National Cancer Institute. About 45% of men ages 70 and older reported receiving the screening blood test, although the preventive test is not recommended by the U.S. Preventive Services Task Force after age 69.
  
  However, if a patient is at a higher risk for developing prostate cancer due to family history, race or ethnicity, they can request a PSA test as part of their annual physical.
• A high PSA reading is always an indicator of prostate cancer.
  “This is not true,” says Rezazadeh, a medical oncologist who specializes in genitourinary disorders.
  
  “Although we see high PSA levels in a majority of cases, the worst prostate cancers that lead to death very quickly are the ones without very high levels.”
• Prostate cancer can always be diagnosed in early stages with PSA screening.
  “PSA is not a perfect test and it doesn’t detect every prostate cancer early,” says Lee.
  
  Especially aggressive cancers can develop and progress between annual PSA screenings, Rezazadeh notes.
  
  Moreover, some prostate cancers spread so fast they don’t produce prostate-specific antigens that could be detected by the test, Lee adds. “This diminishes the efficacy of the test for the unfortunate few. In fact, most men with early metastasis feel completely normal and don’t have any symptoms.”
• Most men will die with, not from, prostate cancer because it is usually slow growing.
  Untrue, says Rezazadeh. “Unfortunately, it is the second leading cause of cancer death in men, after lung cancer.”

Better treatments

The good news is that advances in treatment have led to many men living longer with prostate cancer, the physicians said.

As with most cancers, early detection is key. Lee recommends that men in their 50s should discuss the benefits of prostate cancer screenings with their primary care physician. Those at higher risk for the disease – men who are Black, have a family history of prostate cancer or other risk factors – may need to start the conversation sooner.

Annual screenings typically include the PSA test and a digital rectal exam. A sudden jump in PSA levels or abnormalities in the texture, size and shape of the walnut-size gland may prompt a referral to a urologist for further studies, which may include ultrasound, magnetic resonance imaging or a prostate biopsy.

Individualized care

The UCI Health prostate cancer team takes a multidisciplinary approach to the diagnosis and treatment of the disease. Team members consult with fellow urologists, oncologists, pathologists, diagnostic radiologists, radiation oncologists and other healthcare specialists to evaluate each patient’s case and determine the best options.

Treatments may include radiation therapy, hormone therapy, immunotherapy, cryotherapy, chemotherapy and robot-assisted surgery. Patients also receive ongoing surveillance to support them and their loved ones throughout their cancer journey.

“For some people, prostate cancer doesn’t need to be treated,” said Rezazadeh. "Instead, we monitor the cancer’s growth and intervene when needed.”

Emphasizing quality of life

In more aggressive cases when the cancer has spread beyond the prostate gland, the team first considers a patient’s overall health and quality of life to determine whether other conditions may affect their ability to tolerate treatment and potential side effects.

Above all, the prostate cancer team of specialists works collaboratively to provide each patient with the highest quality, personalized care in a unique and comforting environment. Patients also have access to the latest clinical trials for the disease.

The team is also investigating genomic markers and ways to better stratify patients by low, medium and high risk to further refine treatment regimens.

Learn more about the UCI Health Comprehensive Prostate Cancer Program ›

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