Since 1985 over one million men have been treated for possible prostate cancer because their prostate-specific antigen (PSA) test came back elevated.  Over 5,000

Prostate Cancer is Now a Watch and Wait

died soon after treatment and over 300,000 others suffered severe side effects from the treatment.  Impotence, urinary incontinence (from surgery) and rectal bleeding (from radiation) are examples of these effects.

In 2008 the US Preventive Services Task Force looking at the PSA guidelines recommended to stop testing men over 75 who were assymptomatic.  In 2009 two more large studies, the European and the US study, looked at men in their 50s and 60s, one group getting no testing unless showing symptoms, and the second group getting a PSA test and/or a digital rectal examination.  If anyone in this second group appeared abnormal, biopsy and additional surgery was recommended.  In neither study did either group of men live longer.

The problem is an elevated PSA can be caused by factors other than cancer.  Even with a biopsy showing cancer, 50% of men in their 50s, and 75% I their 80s died of some other cause than prostate cancer. A Canadian study showed the death rate of those with elevated PSA and positive biopsies was 1% over 10 years with no intervention or surgery.  Those that elected prostate surgery had a 0.5% death rate in the first month following the surgery.  Virtually no difference.

Bottom line: Make your own decision but watch and wait would be the best recommendation at this time (but with periodic PSA tests and treatment only with rapidly increasing levels).