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by GingerSue

I am reading about health teaching to prevent cancer.
My material says that ther is debate about the use of the PSA blood test to screen for prostate cancer, and that men should have the opportunity to have a PSA test after being informed of its risks and benefits.
So I googled and all that I've found about risks is
phlebitis, bruising at the site
and that there might be a false positive result (caused by infection, irritation, or benign prostatic hypertrophy or hyperplasia)

Are there some other risks of PSA test?

[TazziRN]

Re: what are risks of PSA blood test?

Nooo...........these are the risks of any blood tests............

[mystic_fish0526]

Re: what are risks of PSA blood test?

It's a blood test, so I can't really think of any other risks other that those related to venipuncture. False-positive is not really a "risk", just a need for further testing.

[GingerSue]

Re: what are risks of PSA blood test?

or it says that cancer can be present when the PSA is not elevated

[tiredfeetED]

Re: what are risks of PSA blood test?

Your right a PSA can be low and pt still can have CA present or can have a elevated PSA and be negative, this varies with age.
The serial measurement of PSA (PSA velocity) may increase specificity for cancer detection. A change of 0.75 ng/ml per year is associated with an increased likelihood of cancer detection. (source; CMDT 2006)

Personally I do not see any reason why a pt should be informed of risks of drawing a PSA as part of health care maintance along with a Digitial rectal exam.

[Jolie]

Re: what are risks of PSA blood test?

Originally Posted by tiredfeetED

Personally I do not see any reason why a pt should be informed of risks of drawing a PSA as part of health care maintance along with a Digitial rectal exam.

I'm not sure I understand your post. Do you believe that it is unnecessary to inform a patient of the potential risks of having a PSA done?

If so, I disagree. Patients have every right to know the risks of their tests, treatments, medications, etc., even if the healthcare provider regards them as trivial. PSA tests have a fairly high rate of false-positives. That means that a patient may be exposed to further tests including biopsies. Patients have the right to know that upfront so they can make informed decisions about whether or not to consent to the PSA.

[TazziRN]

Re: what are risks of PSA blood test?

I have never heard a pt being warned, nor have I ever been warned, that phlebitis or false result was the possible risk of a blood test. If a positive result is obtained, then the possibilities of it being false can be discussed as well as the next step.

[Jolie]

Re: what are risks of PSA blood test?

Originally Posted by TazziRN

I have never heard a pt being warned, nor have I ever been warned, that phlebitis or false result was the possible risk of a blood test. If a positive result is obtained, then the possibilities of it being false can be discussed as well as the next step.

Tazzi,

Maybe I'm hyper-aware of cautioning patients to the "risk" of a false-positive because of my background in OB. The triple-screen test is one of the most widely done blood tests in OB, yet is poorly understood by most healthcare professionals and often poorly-explained to patients. Many patients who initially consent to the test later state that they would never have done so if they had understood the likelihood of a false-positive, and all of the worry and invasive testing that follow a false positive.

I realize that there is a HUGE difference between a PSA and a triple screen, but my outlook on all labwork is tempered a bit by my experience with this one.

[nj1grlcrus]

Re: what are risks of PSA blood test?

PSA can also be elevated soon after ejaculation, so if the deed was done early AM before the test, many blood tests are scheduled for early AM. Just a thought... Patient should request a second test..I also can't find my source for this, but I did see it somewhere a few months ago
PS also elevated due to benign prostate hypertrophy, prostatic infarct, and urinary retention

[group_theory]

Re: what are risks of PSA blood test?

I think the "risk/benefit" that the material is referring to with PSA is not about the actual blood draw itself but the usefulness of using PSA as a screening tool for prostate cancer.

Like others have mentioned before, PSA is neither sensitive or specific. A "normal" PSA doesn't mean you don't have prostate cancer, and a high PSA doesn't mean you do have prostate cancer. Imagine trying to discuss the specifics of PSAs with your otherwise healthy asymptomatic patients

Besides the risk of false negatives and false positives, there is also the risk of any subsequent workup/procedures (ie prostate biopsy) resulting from an elevated PSA.

Also, even if it is prostate cancer, depending on the staging and aggressiveness, the patient may likely die from something else before the prostate cancer can even have a remote chance to kill the patient. If this was the case, would you ignore the prostate cancer or treat it (and subsequent risk of treatment along with side effects of cancer therapy).

case scenerio:
If an 85 year old male with DM, HTN, CAD, COPD, ESRD, h/o CVA x 2, h/o STEMI, h/o DVTs and PEs along with mild dementia, was found to have prostate cancer, would you subject him to aggressive treatment for his prostate cancer? (the treatment itself can kill him). Is the risk worth the benefit? If you can turn back the clock, would you do a PSA level on him? (there is no right or wrong answer here ... it's up to the patient, his family, and his physicians to discuss the risk/benefit/prognosis and decide where to proceed)