Like it or not, there is no simple guideline for prostate-specific antigen (PSA)-based screening. Instead of automatically ordering the test for a set population, consider having a conversation with your patients.
For men ages 55 to 69, explain the potential benefits and harms of screening, and gauge their preferences. PSA-based testing is not recommended for men ages 70 and over.
Why is shared decision-making necessary when it comes to the PSA test? The U.S. Preventive Services Task Force warns of the possible harms of screening, including false-positive results and overtreatment. False-negative results can also occur — men can have prostate cancer, but low PSA levels.
Given these limitations, it's important to help patients weigh the pros and cons, and empower them to make an informed choice. Keep in mind that some Medi-Cal patients have low health literacy and numeracy — you may need to adapt your usual "script" to meet their needs.
For more information about prostate cancer and PSA-based testing, visit the Centers for Disease Control and Prevention Prostate Cancer site.