Should every man have a PSA test? No. The goal of PSA testing is to identify curable cancers in men who are probably going to live long enough to need to be cured. Therefore, there is no reason for most men over age 75, or is man with a life expectancy of less than ten years, to have a PSA test. Creating anxiety about what to do—what treatment decisions to make—is not helpful, humane or necessary for these men.

If something abnormal is found in the digital rectal exam, regardless of your PSA level, you should have a prostate biopsy. (This is done with the help of transrectal ultrasound; biopsies ).It ‘the rectal exam is normal and your PSA is greater than 4, you should also have a biopsy.

The number 4 comes up often in discussions of PSA and prostate cancer. That’s because it has become something of a «magic number.» Many doctors believe that a PSA level greater than 4 is abnormal, and a PSA less than 4 means everything’s fine. But more and more doctors are realizing that having a strict cutoff number probably isn’t the best way to use PSA, and they’re beginning to use other definitions for early diagnosis of prostate cancer.

One of these is called PSA density, in which the PSA number is divided by the prostate size, which is estimated by transrectal ultrasound. The reason size is important is that having BPH (benign enlargement of the prostate) can make PSA higher anyway—so it’s tougher for doctors to distinguish between BPH and cancer. Basically, if you have benign enlargement, your PSA should not be more than 15 percent of the weight of your prostate. If it’s greater than that, advocates of PSA density believe, vou should have a biopsy.

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