PSA Screening and Prostate-Cancer Prevention: What Every Man Needs to Know
By Yu-Hung Lin, MD, Senior Attending, Department of Urology, KFSYSCC
News that former U.S. President Joe Biden was reportedly diagnosed with prostate cancer that had already spread to his bones set off an international ripple of concern. The story—even if partly speculative—underscores a simple truth: prostate cancer remains a formidable threat. In Taiwan the disease now ranks third among men for both incidence and mortality, with nearly 10,000 new cases a year; most are discovered late. The single test that can tip the odds back in our favor is the prostate-specific antigen, or PSA.
What PSA Really Is
PSA is a protein produced by prostate tissue and measurable in the bloodstream. Levels rise with gland size, inflammation, or infection—not just cancer—yet an unexplained spike is often the first red flag that a tumor is present. Because no other blood marker correlates so closely with prostate malignancy, PSA has become the frontline screen for men at risk.
A Success Story—With Caveats
The United States adopted PSA screening broadly in the early 1990s. Diagnoses soared; early-stage detection leapt from below 30 percent to over 80 percent, and prostate-cancer mortality fell. The downside emerged later: PSA is so sensitive that it also flags “indolent” tumors—cancers that would never have harmed the patient. Treating those slow growers can leave men with urinary leakage or sexual dysfunction yet no survival benefit. Medicine still cannot predict with perfect accuracy which tumors can be safely watched and which demand immediate action, so every PSA result must be weighed carefully.
Who Should Be Tested—and When?
The latest American Urological Association guidance, which Taiwan increasingly follows, makes age and risk the linchpin of decision-making:
Men 55 to 69 gain the most: tracking 1,000 men in this group for a decade shows that PSA screening prevents one prostate-cancer death, a meaningful public-health impact. Each man should discuss timing with a urologist.
Men under 40 face such low incidence—and such high false-positive rates—that routine testing is not advised unless symptoms or strong family history exist.
Men 40 to 55 or over 70 fall into a gray zone. Family history, overall health, and personal values should guide the choice.
Testing every two years appears optimal; annual testing offers little added survival gain yet increases anxiety and overtreatment.
Turning Numbers Into Wisdom
Because benign enlargement and prostatitis can also elevate PSA, the test is never diagnostic by itself. Abnormal results usually lead to repeat testing, MRI imaging, or targeted biopsy before committing to treatment. If you are considering PSA screening, bring your family history, current medications, and any urinary or bone symptoms to the consultation. Together you and your physician can map out a screening schedule that maximizes benefit while minimizing harm.
Bottom line: PSA is not perfect, but used judiciously it remains the best early-warning system we have. Talk with your urologist, weigh the evidence, and decide whether PSA testing is the smart move for your health.