PSA (prostate-specific antigen) is essential for prostate cancer screening and monitoring. This episode explores the PSA controversy, explains why annual PSA screening is crucial, and talks about the importance of PSA testing for monitoring prostate cancer treatment. Understand the benefits and drawbacks of PSA, and use this incredible tool to your advantage. Dr. Scholz:  [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.  I'm your host, Dr. Mark Scholz.  Liz:  [00:10] And I’m your cohost, Liz Graves. Dr. Scholz:  [00:13] Welcome to the PROSTATE PROS podcast. Al Roker:  [00:16] I've been feeling great, but my doctor discovered I had an elevated PSA level in my blood work, PSA standing for prostate-specific antigen.  It's the first line of defense when detecting possible prostate cancer. Dr. John Torres:  [00:32] Today, an influential medical task force is changing those screening guidelines.  Now, urging all men ages fifty-five to sixty-nine to talk to their doctor about getting a PSA test.  Men ages seventy and older should not get screened. Dr. Kirsten Bibbins-Domingo:  [00:46] This should really be a personal choice that a man makes together with his doctor, and the goal of these conversations is really to understand benefits and harms. Dr. John Torres:  [00:57] Previously experts…  Liz:  [00:58] There's a lot of confusion and hesitation surrounding PSA screening.  What are the proper steps?  What do you do if the PSA test does come back abnormal?  This episode, Dr. Scholz and I are going to talk about the importance of PSA testing, what a high PSA actually means, and what the best steps to take are to further investigate. Dr. Scholz:  [01:21] The PSA blood test has been around since 1987, about the time my career started it up.  I can't tell you how revolutionary this blood test has been.  Really, we don't have another blood test like this for other cancers.  In some ways, PSA makes prostate cancer a much easier cancer to treat.  In other ways, like any powerful tool, if it's misused, it can create confusion and problems.  I hope we'll be able to bring some clarity to why this blood test can be controversial.  Liz:  [01:57] Everyone knows that PSA tests for prostate cancer.  PSA stands for prostate-specific antigen.  And when this is screened annually in men, it is to look for prostate cancer, but that is not all that PSA does. Dr. Scholz:  [02:15] The problem with PSA as a screening tool and PSA is used for other things besides screening.  But, as a screening tool, men still have a prostate gland.  Typically if they have a small tumor in their prostate, the lion's share of the PSA is actually coming from the gland, the benign prostate, not the cancer.  This is where the confusion comes.  Men will have inflammation of their prostates, and the PSA will be high.  Men will have enlarged prostates, and their PSA will be high.  Or, of course, they could have a low-grade, or a more consequential cancer, and their PSA could be high.  One savvy patient once told me, tell your patients to think of the PSA as a check engine light on the dashboard of your car.  Something's going on in the prostate, it could be cancer, and it could be one of these other causes.  Liz:  [03:12] When a PSA comes back elevated, taking time to understand what that means is crucial.  PSA can be a great tool to tell people they have prostate cancer, but it also has all of these other possible complications.  In 2011, the US Task Force advised against PSA testing.  Why was this Dr. Scholz? Dr. Scholz:  [03:35] Small cancers that don't spread are the root difficulty we have.  There have been active discussions about renaming certain types of prostate cancer as something non-c