Recent renewed attention to prostate cancer and the PSA screening test, spurred by the diagnosis of former US President Joseph Biden, is once again igniting debate among health experts and patients worldwide — including in Thailand. Prostate cancer remains the most commonly diagnosed cancer among men in the United States and is a significant health concern for aging populations globally. The latest research and guidance show that the path forward for PSA (prostate-specific antigen) testing is both complicated and deeply personal, underscoring an urgent need for Thai men and their healthcare practitioners to weigh the pros and cons of screening within the context of current science and local realities.
At the heart of the issue is the PSA blood test, a long-standing but imperfect tool that measures levels of PSA — a protein produced by cells in the prostate gland. Elevated PSA levels can indicate cancer but also commonly lead to false positives or detection of cancers so slow-growing they are unlikely to ever cause harm. As several experts told NPR, autopsies have revealed that over one-third of white men and half of Black men in their 70s in the US had prostate cancers they never even knew about and that never would have affected their health (NPR). This overdiagnosis can lead to overtreatment, inflicting major side effects such as impotence, incontinence, and bowel dysfunction — all for a cancer that may never have been threatening.
For Thai men, these findings are particularly relevant. With populations aging and medical access improving, rates of prostate cancer detection are expected to increase — but so too is the risk of unnecessary interventions. As a radiation oncologist at the University of California, San Diego, noted, “PSA testing alone leaves a lot to be desired as a cancer screening test.” Yet, at present, there are no alternatives that screen for prostate cancer as effectively.
Current international guidance is deeply conflicted and has shifted over the years. In 2012, the US Preventive Services Task Force (USPSTF) advised against routine PSA screening, only to revise its recommendations in 2018: men aged 55 to 69 are now encouraged to discuss screening with their physicians based on personal risk and preference. For men above 70, the advice is clearer: don’t screen, as the harms outweigh the modest potential benefit (US Preventive Services Task Force). Different medical bodies in the US and around the world, including Asian health authorities, offer varying advice, adding to the confusion.
One point of consensus is the value of “shared decision-making.” Experts stress the importance of a detailed discussion between doctor and patient, especially for men between 55 and 69. However, these conversations are often challenging in practice. Thai physicians, like their Western counterparts, face time constraints and an expanding caseload, making comprehensive dialogue difficult — yet it is critical for men to weigh their own priorities, from peace of mind to risk tolerance and anxiety about possible false alarms.
Expert opinions remain divided, particularly when it comes to interpreting research evidence. According to a leading genitourinary oncologist from the Dana-Farber Cancer Institute, the original large clinical trials that downplayed PSA testing’s benefits were methodologically flawed, because most men in the “control” group actually received some PSA testing anyway, muddying the results. Many experts now advocate for more nuanced recommendations: increased screening for black men or those with a family history, who are at higher risk of aggressive disease (National Cancer Institute on African Ancestry), and perhaps earlier screening for these groups in both the US and Asia.
For men who do decide to undergo PSA screening and are found to have elevated levels, a consensus is emerging around a less invasive next step: active surveillance. Rather than immediate and often unnecessary biopsies or treatments, new research supports first using MRI imaging to identify and monitor only those cancers most likely to become dangerous. As a urologic oncologist from the University of California, San Francisco, suggests, not every abnormal finding should be labeled as ‘cancer.’ He advocates renaming very-low-risk disease (such as “acinar neoplasm”) to reduce patient stress and encourage careful watching instead of overtreating. “Men should get PSA testing in midlife with the goal of finding aggressive prostate cancer,” he says. “If we find low-grade disease along the way, whether or not we call it cancer, we should not treat it. We just monitor it with active surveillance.”
This more judicious, stepwise approach to prostate cancer screening — PSA blood testing, followed by MRI and careful monitoring where possible — is increasingly being adopted in leading medical centers and may soon become best practice in Thailand as well. However, the psychological burden of “watchful waiting” or “active surveillance” is real: for many men, knowing they have a tumor, even a benign one, can cause significant anxiety. Doctors report that most patients adapt to this uncertainty over time, especially as they come to understand that slow-growing cancers usually pose little threat.
For Thailand, home to a fast-growing senior population and greater attention to men’s health, these findings have significant implications. While prostate cancer is less common here than in the West, incidence rates are climbing (Thai Cancer Registry), and as awareness rises, more Thai men will face the decision whether to screen — and if so, how to proceed after a positive result.
Some unique cultural considerations also come into play in Thailand. There is strong deference to physician authority and a social reluctance to discuss or even acknowledge prostate or reproductive health issues. Many Thai men delay seeking care for urinary symptoms due to embarrassment or fear of stigmatization. Therefore, the move toward shared decision-making and active surveillance may require targeted health education campaigns and greater training for primary care physicians in counseling and risk communication.
Experts emphasize that Thailand’s healthcare system should also account for disparities in access. In rural areas, MRI technology may be limited, and specialist follow-up for active surveillance may not be uniformly available. Insurance coverage for PSA testing and subsequent MRI also differs among public and private health sectors, potentially impacting the uptake of evidence-based protocols.
Looking ahead, both Thai and international experts are hopeful that robust data from ongoing studies — including those more inclusive of Asian populations — will lead to clearer, more nuanced guidelines. Advances in genomics may soon allow for even more targeted screening protocols, identifying those at highest risk through genetic markers or family history, and sparing low-risk men the anxiety and side effects of unnecessary procedures.
In conclusion, the latest research reveals that the PSA test is not a yes-or-no solution but rather a starting point for a conversation between Thai men and their doctors. Screening can catch aggressive cancers early and save lives, but it can just as easily trigger unnecessary biopsies, treatments, and anxiety. Thai readers are encouraged to talk openly with healthcare providers about personal and family risk, to consider new protocols such as MRI-based monitoring, and to seek out credible public information. For now, the key is informed choice: understand both the potential benefits and the risks, and partner with medical professionals to make the best decision for your own health.
For more information, readers can review recent international guidelines (USPSTF), learn about Thailand-specific prostate cancer trends (Thai Cancer Registry), and consult local hospitals about available screening protocols. Family members should also be aware of the signals for early testing — especially in men over 55, those of African or Asian ancestry, or anyone with a strong family history of the disease.
If you are a Thai man over 55, or if you have a family history of prostate cancer or concerning urinary symptoms, talk to your healthcare provider about PSA testing and discuss not just the test itself, but the next steps if your PSA result is high. Demand up-to-date, balanced information — and remember that the best decisions are those made in partnership, tailored to your personal values and health goals.