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Question : I am 77. My brother died of prostate cancer. My doctor says I don’t need PSA testing at my age. But because my brother died of the disease, my doctor will order the blood test if I want it. I’m not sure what to do. What is your advice?
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The Trusted Source
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Howard LeWine, M.D.

Howard LeWine, M.D., is chief editor of Internet Publishing, Harvard Health Publications. He is a clinical instructor of medicine at Harvard Medical School and Brigham and Women's Hospital. Dr. LeWine has been a primary care internist and teacher of internal medicine since 1978.

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January 25, 2011
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A:

There is no right or wrong answer. Your doctor is following a recommendation from the U.S. Preventive Services Task Force. They advise against routine testing for prostate cancer for men age 75 and older. Recommendations like this help doctors make decisions, but they do not require what should be done in any specific situation.

By the way, the prostate-specific antigen blood test measures the amount of a chemical called prostate-specific antigen (PSA) in a man's blood.

There are three questions that I need answered before I can offer advice:

  1. Are you in good general health? (This means you have no health conditions that would likely cause you severe disability or death within the next 10 years?)
  2. Are you of African descent?
  3. If you are not of African descent, was your brother under age 60 when he was diagnosed with prostate cancer?

If your answer to question one is “No,” you are not in good health, I would advise against your getting the PSA test. Why? Because someone in poor health is more likely to die from some cause other than prostate cancer. So there is little benefit in being tested and treated for prostate cancer.

If your answer to question one is ”Yes,” you are in good health, and your answer to question two or three is ”Yes,” then you should consider getting the PSA test.

Keep in mind that even if your brother died of prostate cancer that was diagnosed before he reached age 50 and/or you are of African ancestry, you are still more likely to die from some cause other than prostate cancer. But, it is likely that your risk of aggressive prostate cancer is higher than average.

You should review all the possible complications of testing and prostate cancer treatment before getting the PSA test. If you decide you want the test, tell your doctor. If your doctor agrees (I would), he or she will also perform a digital rectal examination as part of the screening.

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