PSA: Giving Prostate Cancer the Finger



"How long has it been since someone put their finger in your ass?" I asked my 51-year old brother a few days after I was diagnosed. He quickly guessed the punchline and asked if I had prostate cancer. I told him the deal and he assured me that he gets regular check-ups.


While the aforementioned digital rectal exam (DRE) where your health care provider inserts a gloved, lubricated finger into your butt to check the prostate for anything abnormal used to be the primary assessment, the folks at the US Preventive Services Task Force have stopped recommending DRE as a screening tool. Turns out, it's not very effective and men often avoid physicals entirely because they "fear the finger."


Health authorities instead recommend a prostate specific antigen (PSA) test that measures the level of PSA in the blood. PSA is a protein made by the prostate and PSA levels of 4.0 ng/mL and lower are considered "normal." The levels of PSA in the blood can be higher in men who have prostate cancer and as general rule, the higher the PSA level in the blood, the more likely a prostate problem is present. Still many factors, such as age and race, can affect PSA levels as can medications, an infection or even extended time riding a bike and the PSA test isn't without controversy.



The American Cancer Society (ACS) recommends that men make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. They say that the discussion about screening should take place at:

  • Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.

  • Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father or brother) diagnosed with prostate cancer before the age of 65.

  • Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer before the age of 65).

I missed my physical during COVID in 2021 and a PSA of 4.320 on February 7, 2022 caught my primary care doctor's attention because that number was just 2.4 on January 30, 2020. I had zero symptoms, so without that routine check-up, I would still be in the dark about my diagnosis. My prostate cancer would be growing and spreading each and every day.


The PSA test alone won't get you a cancer diagnosis - there are other tests for that - but it can signal a potential problem and is an important part of men's health.