Dr. Catalona’s Recommendations for PSA Testing

Categories: Spring 2008

Click here to read more Quest articles. | Print this page Dr. Catalona’s Recommendations for PSA Testing
by William J. Catalona, MD

My feeling is that testing should begin at age 40 but not because prostate cancer is a common problem in 40-year old men – although it does occur in 40-year-old men .

One of the things we’re learning about PSA testing is that the trend of the score is almost as important as the PSA level itself. So if the PSA starts trending upward, then that rise is worrisome for prostate cancer.

In regards to ethnic background, prostate cancer is more common in African-American men – 50 percent higher than in white men. And the death rate is 200 percent higher because it tends to be diagnosed at a later stage and tends to be slightly more aggressive.

In regards to family history, one in every six men will be diagnosed with prostate cancer during his lifetime but that risk doubles with a family history of prostate cancer. And if a relative developed prostate cancer at an early age of 50 or younger, then it’s more likely other men in the family will too.

A man’s family history is very, very important. Also, a strong family history of cancer in women in the family, especially breast cancer developing at an early age, is important.

For these reasons, I believe that every man should begin getting an annual PSA test at age 40, and even begin at age 35, if they have a family history of early onset prostate cancer.


More than 90% of all prostate cancers are discovered in the local and regional stages; the 5-year relative survival rate for patients whose tumors are diagnosed at these stages approaches 100%.

According to the most recent data, relative 10-year survival is 93% and 15-year survival is 77%. The dramatic improvements in survival, particularly at 5 years, are partly attributable to earlier diagnosis and improvement in treatment.

Modern methods of detection and treatment mean that prostate cancers are now found earlier and treated amore effectively. If a man is diagnosed this year, his outlook is likely to be better than the numbers reported above.

Modern methods of finding and treating prostate cancer have led to a yearly drop in death rate from prostate cancer. Men treated today may have an even better outlook than the numbers above.

Source: American Cancer Society

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