What age should my son start PSA testing

Hi as a prostate survivor What age should my son start PSA testing.

What Djin said: most often I hear 40 as a good age to get a PSA test and maybe every couple of years after that till 50 then yearly.

But with genetic testing the guidelines might be changing a bit. It's a good conversation for him to have with his doctor.

In my case, my brother was DXed with PC when I was 51. During a routine physical my doc asked me about family cancer history and I mentioned this. That lead to a PSA test, then another, a biopsy and me joining this fine forum. I'm happy it happened that way as I believe it lead to be getting DXed early and getting treated before things got bad.

Andrew

I started in my 40's at my dad's recommendation-he was dealing with his own PC. My PCP was of the--OK, you're a bit younger than we usually start, but no problem....and I had a string of non-detects (standard test) until I was 53, when it started it's climb that led to diagnosis at 56.

When you see a guideline that says to start at age x, you naturally think that if there is some risk at age x, then the risk can't be zero at age x - 1 years, and so on. So you may as well start early (or no later than age x) and gain some peace of mind.

Djin

Post Edited (DjinTonic) : 2/12/2020 7:04:28 AM (GMT-7)

halbert said...
This may not be empirically correct, but it does seem as if there are a lot of men under 45 who are getting diagnosed these days--and they tend to be really severe cases. So, does it make sense to have PSA be part of a normal male blood panel starting at a young adult age?

To me that makes sense. Public-health policy seems to be driven with NTT, number to treat or number to test, which gives you a bird's-eye view, but an individual's view is different -- somebody is in those small percentages, and I see nothing wrong with making sure it isn't you or a loved one. Also, we should look at what the "cost" is -- a blood test added on to the many you get for your PE. As many have said, the remedy for overtreating G6 men is not reduced testing, but rather better education about AS. You can't find those low-risk G6 men who can go on AS without first finding all G6 men.

Let's hope liquid biopsies (on blood, urine) make it out of testing to mainstream soon. There are a small but unfortunate number of men with very aggressive PCa that doesn't raise PSA out of the normal range. That makes current screening practically useless.

Clinical and Genomic Characterization of Low-Prostate-specific Antigen, High-grade Prostate Cancer [2018, Full Text]

"Conclusions:
Low-PSA, high-grade prostate cancer has very high risk for PCSM, potentially responds poorly to androgen deprivation therapy, and is associated with neuroendocrine genomic features."

Editorial on this study [2018]

Djin

Post Edited (DjinTonic) : 2/12/2020 9:41:18 AM (GMT-7)

From an AUS Prostate Cancer publication:
https://www.prostate.org.au/media/612113/psa-testing-guidelines.pdf

Couple of quotes:
"For those who decide to have prostate cancer tests, the general recommendation is to have a PSA blood test every 2 years from age 50 to age 69. For men whose risk of prostate cancer is higher than average (e.g. with a brother diagnosed with prostate cancer), regular testing can start earlier."

"For men younger than 50 years who are concerned about their risk for prostate cancer, have been informed of the benefits and harms of testing, and who wish to undergo regular testing for prostate cancer, offer testing every 2 years from age 45 to age 69 years.If initial PSA is at or below the 75th percentile for age, advise no further testing until age 50.If initial PSA is above the 75th percentile for age, but at or below the 95th percentile for age, reconfirm the offer of testing every 2 years. If a PSA test result before age 50 years is greater than the 95th percentile for age, offer further investigation.Offer testing from age 50 years according to the protocol for all other men who are at average risk of prostate cancer."

My Dad was diagnosed with PCa in his 70's and I got tagged in my 60's. The family relationship is a strong PCa influence for not totally clear reasons but it is. Since you were diagnosed in your late 50's, starting in his 40's sometime would be prudent. The published guidelines go a long way towards letting you know what will be accepted without a lot of trouble and he may have to insist at some point with some doctors. Like others have said, when he decides to go for annual physical exams, a PSA is an inexpensive test to add to the list. Not many men do annual physicals before age 40 (still in the Superman stage of life) unless part of work requirements. Many men don't until their 50's or 60's so encouraging annual physicals at some point is good for all the other treatable things that end life early.

Tony, the "problem" with starting PSA testing early is that indolent cancer may be found and the young man may jump to a radical treatment (i.e. overtreatment). The "opportunity" of starting early is that if there is cancer it will be found early with the chance to treat it before it becomes more serious.

Having said that and having thought about this quite a bit since the overtreatment discussions began a few years back, I would concur that age 40 seems reasonable. However, someone (you?) needs to have the quality of life discussion with your son if he does start testing so that he understands what might happen if he treats the cancer and what options he might have if the cancer tests out at G6.

Jim

"Tony, the "problem" with starting PSA testing early is that indolent cancer may be found and the young man may jump to a radical treatment (i.e. overtreatment)."

translation = you may fall in the hands of a prostate snatcher. that's really what's meant by overtreatment.

My thoughts are shaped by direct experiences ...

I represent the third generation of my family diagnosed with prostate cancer (my grandfather, my father, and now me).

I was diagnosed with prostate cancer in my 40s, which had already infiltrated both my lungs.

It was a sobering day, with my doctor stating I had just become his youngest prostate cancer patient.

My doctor currently treats my father AND now me --- both of us being prostate cancer patients.

Since then, several of my very closest friends have been diagnosed, also with advanced prostate cancer --- all of them in my age range.

We have all lost comrades here on this website.

Two of them, JPENN44 and JOHN16, kept in touch with me until the very end of their lives.

JOHN16 passed at the age of 55 years, while JPENN44 passed at the age of 44 years --- both of them valiant in their fight against prostate cancer. Both of them became advocates for prostate cancer awareness.

It seems the message of awareness and early screening for breast cancer has been well communicated and shared in recent years. That message has no doubt saved countless lives, due to early detection and the importance of health screenings.

You see a pink ribbon, and it immediately sends a message of breast cancer awareness.

I think we -- as brothers and comrades here --- need to continue to do what we can to provide information and awareness about PROSTATE cancer awareness. Why wouldn't we want the very best health awareness for other fellows?

The color for prostate cancer awareness is LIGHT BLUE. I hope light blue ribbons become as recognizable as the pink ribbon campaign.

My thoughts to share today, based on my experiences ---
Cyclone --- Iowa State University