Dr. David Samadi affirms advantages of PSA testing for men under age 50


Dr. David Samadi affirms advantages of PSA testing for men under age 50

Prostate cancer is not just an old man’s disease.  Young men can get it too and Dr. David Samadi shines a light explaining why men younger than age 50 should get a PSA test as a baseline for comparison in the future.

Every September is designated as Prostate Cancer Awareness Month dedicated to bring attention to this disease.  I am a firm believer in the significance of all men beginning at age 40 choosing to undergo a single prostate specific antigen (PSA) test.  In order to be able to detect prostate cancer at its earliest and most treatable stage, having a baseline level done early in life can be extremely useful for comparison in the future.

As a urologist/oncologist, I’ve dedicated my career to make men and their families aware of the second most common cancer in American men other than skin related cancer. Currently, one in nine men will be diagnosed with prostate cancer at some point in their lives.  African-American men have an even far greater risk of a one-in-three chance of being diagnosed. Each year, more than 26,000 men die from prostate cancer making it the second leading cause of cancer death in men.  That’s why I stress early detection beginning already at age 40 to be a significant part of saving lives.

What is a PSA test?

The PSA test is a simple blood test that measures the amount of prostate specific antigen present in the blood to screen for prostate cancer.  PSA is a protein men have in their blood released by the prostate gland.  In healthy men, the amount of PSA is low – generally less than 4.0 ng/ml.  However, as men age, their prostate can experience physiological or pathological changes which cause the PSA to rise.

However, there are differences of opinion among healthcare professionals and researchers on what age to begin baseline PSA testing. In 2012, the United States Preventive Service Task Force (USPSTF) advocated against urologists from using the Prostate Specific Antigen (PSA) test to screen men of any age for prostate cancer. I strongly advised against that and still do. Their argument was that the benefits of PSA testing may not justify the cost of implementing PSA as a screening tool in that the PSA exam and additional treatments such as radiation and surgery, result in far more harm than benefit.  However, PSA is an excellent diagnostic tool that can find prostate cancer in men in their 40’s when it is often more aggressive.

Research findings supporting PSA testing

A 2016 study in the journal of Urologic Oncology I published compared 2,495 of my patients with prostate cancer who underwent SMART prostate cancer surgery.  SMART is a minimally invasive, robot-assisted procedure I have used in my practice for many years. 

The results showed younger men when compared to older men with similar demographic, clinical, and pathologic function, had surgical recovery statistically superior to the older men.  Post-surgery 12 months later, 94 percent of the young men and 83 percent of older men had normal sexual function.  When looking at urinary continence 12 months later, results were even better with 96 percent of young men and 94 percent of older achieving normal functioning.   These findings demonstrate that young men under the age of 50 should be screened treatment and surgical outcomes are more favorable at a younger age. With the current technology in robotic surgery, this makes it a literal lifesaver for many young men with a prostate cancer diagnosis.

This same study also found waiting until screening a man’s PSA until the age of 50 or older, can result in missing an early diagnosis in up to 11% of patient who have the disease. Approximately 271 men from the study were found to have prostate cancer at the mean age of 46.

Another study in 2014 looked at the alarming nearly 6-fold increase in the last 20 years of younger men being diagnosed with prostate cancer.  What the researchers found was when prostate cancer strikes at a younger age, it’s likely because the tumor is growing quickly.  This is one of my main arguments for supporting PSA baseline at age 40.  Early onset prostate cancer is usually aggressive hitting men at the prime of their life.  If we can get a baseline early in life, talk to young men about risk factors and any possible genetic components they may have, this is a better plan than waiting until it may be too late.

Main takeaway

Delaying PSA screening until after the age of 50 can lead to a greater likelihood of some men diagnosed with an advanced stage of the disease that may have already metastasized complicating treatment and the outcome.

In my professional opinion, my recommendation still stands to start PSA screening at age 40.  Not only is this a prudent step in the right direction of looking out for men’s health but also for having a baseline level for comparison with future PSA tests. Let’s be proactive by screening early and educating men on prostate health, symptoms of prostate cancer and how to stay cancer free.

Patients newly diagnosed with prostate cancer can contact world renowned prostate cancer surgeon and urologic oncologist, Dr David Samadi, for a free phone consultation and to learn more about prostate cancer risk, call 212-365-5000.