Dernière mise à jour : 18 mai 2026
A common consulting in my urology office involves patients referred with an elevated PSA value from routine screening, using a cutoff of 4.0 ng/mL. This frequently causes significant psychological distress, and I spend considerable time explaining what it actually means. Let me give you an updated perspective on PSA screening.
Qu'est-ce que le PSA ?
PSA stands for Prostate Specific Antigen – an enzyme produced exclusively by the prostate gland. Its function is to liquefy semen after ejaculation. PSA is normally present in high concentration in prostatic tissue and very low in the bloodstream. When prostate tissue is disrupted – by benign prostatic hyperplasia, infection, or even minor manipulation – PSA leaks into the bloodstream and elevates the test value. These non-cancer causes are called “false positive” results.
In 2018, a landmark US study reviewed PSA screening recommendations and concluded that universal screening is not for everyone. There is modest benefit for the age group 55–69 years old, and no benefit for men aged 70 and above. Here is why:
- The goal of screening is to detect high-risk localized prostate cancer that can be successfully treated
- Low-risk prostate cancer is often indolent – autopsy studies show 33% of men who died from other causes had undetected prostate cancer
- Only approximately 1 in 1,000 screened men truly benefits from the test
- False positive PSA results lead to unnecessary prostate biopsies with complications including pain, blood in urine, blood in semen, and infection – plus risks from subsequent prostate surgery including erectile dysfunction and urinary incontinence
So what should you do? If you are male aged 55–69, discuss PSA screening with your primary doctor and make an informed individual decision together. It is your choice. If you have a high PSA level, visit this link for more information, or come see moi à mon bureau.
If you have questions about PSA screening or have received an elevated PSA result, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. Prendre rendez-vous.
Frequently Asked Questions about PSA Screening
PSA (Prostate Specific Antigen) is a blood test that measures the level of an enzyme produced by the prostate gland. Elevated PSA may indicate prostate cancer, but it can also be raised by benign conditions such as BPH, prostatitis, or even minor prostatic manipulation. It is used as a screening tool for prostate cancer, particularly in men aged 55–69, but must be interpreted carefully in context with other clinical information.
No. Current evidence does not support universal PSA screening. A 2018 landmark US study found modest benefit only in men aged 55–69, and no benefit in men aged 70 and above. Routine screening can lead to false positive results, causing unnecessary anxiety and prostate biopsies. The decision to screen should be individualized through shared decision-making between the patient and their doctor.
An elevated PSA does not automatically mean prostate cancer. Common non-cancer causes of high PSA include benign prostatic hyperplasia (BPH), acute prostatitis, urinary tract infection, and recent prostatic manipulation. A urologist will evaluate the PSA level in context with age, prostate volume, PSA trend over time, and clinical findings before recommending a prostate biopsy. Many men with elevated PSA do not have cancer.
The main risks of PSA screening stem from false positive results. A falsely elevated PSA may lead to a prostate biopsy, which carries risks including pain, hematuria (blood in urine), hematospermia (blood in semen), and infection. If biopsy leads to unnecessary treatment for indolent (non-harmful) cancer, additional risks include erectile dysfunction and urinary incontinence from surgery or radiation. These harms affect far more men than those who genuinely benefit from screening.
Current evidence supports considering PSA screening in men aged 55–69 after an informed discussion with a doctor about the potential benefits and harms. Men with higher risk – such as those with a first-degree relative with prostate cancer or African-American men – may benefit from starting discussions earlier, around age 40–45. Men aged 70 and above generally do not benefit from PSA screening according to current guidelines.
Avis de non-responsabilité : Ce contenu est rédigé et revu par le Dr Soarawee Weerasopone, urologue certifié au siège de Bangkok Hospital. Il est destiné uniquement à des fins éducatives et ne constitue pas un avis médical. Consultez toujours un professionnel de la santé qualifié avant de commencer tout traitement médical.
Rédigé et révisé par des médecins : Dr. Soarawee Weerasopone (Dr. Pom) – Urologue certifié, Hôpital de Bangkok (siège). Fellowship international : Baylor College of Medicine (États-Unis) · Juntendo University (Japon) · Chang Gung Memorial Hospital (Taïwan).
Le Dr Soarawee Weerasopone (Dr Pom) est un urologue certifié au Bangkok Hospital Headquarters, spécialisé dans la santé masculine, la chirurgie robotique (système Da Vinci) et le traitement des calculs rénaux. Il a effectué des bourses internationales au Baylor College of Medicine (États-Unis), à l'hôpital universitaire Juntendo (Japon) et à l'hôpital commémoratif Chang Gung (Taïwan). Tout le contenu médical de ce site est rédigé et révisé par le Dr Soarawee, sur la base de son expérience clinique et de sa formation internationale.
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