Should You Get Prostate Cancer Screening?

A recent report said healthy guys can stop getting prostate-specific antigen (PSA) tests, the gold standard of prostate cancer screening. Should you take that advice?

Well, we're pretty healthy guys and here's our take: Don't delete "Get PSA test" from your planner. Here's why: Before PSA testing, 80% of prostate cancer was discovered after it had fatally spread. Today, the combo of the PSA test and better prostate cancer treatments saves 9,000 lives a year. That's not peanuts. Plus new genetic follow-up tests are coming soon that will be able to sort out aggressive prostate cancer (10% -- the kind that needs treatment, pronto) from slow, "indolent" types (90% -- the kind that's unlikely to be a problem).

Meanwhile, here are the PSA test questions you're likely to face and what we think your answers should be. Discuss 'em them with your doc; it will do your peace of mind good.

1. Are you at high risk for prostate cancer? Start annual PSA tests early. Begin at 45 if you're African-American (your risk is 60% higher) or if your father or a brother has had prostate cancer, especially before 50; that doubles your risk. Smoking and excess pounds also increase your risk of prostate cancer.
2. Are you at average risk for prostate cancer? Start PSA tests at 50. Keep them up until your physical age -- your body's RealAge, not its calendar age -- is 65. The younger and healthier you are, the longer you should be screened for prostate cancer.
3. Do you need an annual, manual check? Yep. Sure, it's the punch line of a million jokes but a yearly rubber-glove exam of your prostate, plus a digital rectal exam (DRE), can catch the 25% of problems a PSA test misses. If something unusual turns up, get a PSA test.
4. What if your PSA levels are high? Take a breath. Only 18% to 30% of high PSA test results actually mean prostate cancer. First, get a retest. An infection or even a roll in the hay shortly beforehand could have temporarily boosted your PSA level. Also, ask about "percent free" PSA, a type that floats around in your blood, unattached to other molecules. The less you have, the higher your prostate cancer risk.
5. If you get a scary PSA test result, get a second and maybe a third opinion. Up to 40% of guys with early prostate cancer can opt for "active surveillance," also called "watchful waiting," which monitors the cancer with regular PSA tests, prostate exams, and biopsies. If trouble arises, treatment starts. We love this approach because it lets you make healthy changes that are proven to keep PSA levels lower even after a prostate cancer diagnosis. The changes: more fruit and veggies, more exercise, more meditation; and no red meat, added sugars, or syrups. Follow these -- especially the "no's" -- as if your life depended on them. It may.

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