Recent news of former US President Joseph Biden’s advanced prostate cancer has reignited global debate, including among Thai health professionals and men, about the value of prostate-specific antigen (PSA) blood tests for the early detection of prostate cancer. Prostate cancer, the most commonly diagnosed cancer among men in the United States and an important concern worldwide, presents a unique challenge: distinguishing aggressive, potentially deadly tumors from slow-growing ones that may never pose harm. This ongoing health debate holds particular significance for Thai men, as prostate cancer incidence in Thailand has gradually risen—mirroring trends in the West as life expectancy increases and populations age. Understanding the evolving research on PSA testing can help Thai families make informed decisions about their own health.
PSA tests, used since the 1990s, measure the level of PSA, a protein produced by the prostate gland, in the blood. Elevated PSA levels can suggest cancer, but they can also lead to both false positives and the detection of cancers so indolent that they would never cause harm. Autopsy studies in the United States have shown that over one-third of white men and half of Black men in their seventies had such “silent” prostate cancers. This means unnecessary biopsies, overtreatment, and potential side effects—namely impotence, urinary incontinence, and bowel dysfunction—remain major concerns. As radiation oncologist Dr. Brent Rose of the University of California, San Diego, explained, “PSA testing alone leaves a lot to be desired as a cancer screening test.”
Globally, and in Thailand, health professionals and policymakers seek a careful middle path: identifying and treating aggressive, life-threatening cancers, while avoiding treatment of slow-growing tumors unlikely to impact one’s lifespan. International recommendations on PSA testing have fluctuated for decades. In 2012, the US Preventive Services Task Force (USPSTF) advised against any screening. By 2018, the recommendation changed, leaving the decision to men aged 55 to 69 after shared decision-making with healthcare providers—a position recognized as “Grade C,” offering only a modest benefit. For older men, the advice is clearer: men above 70, and also those 75 or older, are generally advised not to undergo routine PSA screening, a guideline now increasingly reflected in Thai clinical practice and health insurance coverage.
The uncertainty isn’t just in the US. Thai experts echo that determining the importance of PSA screening is not straightforward. As noted in the NPR report, men like President Biden, who stopped PSA screening after age 71, followed the prevailing advice. Urologists and oncologists here in Thailand, working in both public and private hospitals, report similar confusion and anxiety among Thai men and their families considering the test. Many favor the concept of “shared decision-making”—an in-depth conversation with a trusted doctor—before deciding to undergo screening. Yet, as specialists explain, such nuanced discussions are often hampered by short primary care appointments and limited local education about prostate cancer’s risks and natural history.
Some experts believe the pendulum is swinging back toward broader screening, particularly for men at higher risk. Dr. Alicia Morgans, a leading US genitourinary oncologist, challenged the clinical trial that underpins current US guidance, citing “contaminated” control groups (meaning many “unscreened” men actually had received PSA tests). She advocates for clearer, stronger screening recommendations, especially for Black men or those with a family history—a perspective relevant for Thai men with similar risk factors. Thai urologists similarly recommend earlier and more vigilant screening for men whose fathers, brothers, or sons have been diagnosed with prostate cancer.
Nevertheless, international and Thai guidelines stress that screening should not automatically lead to treatment. Urologic oncologist Dr. Matthew Cooperberg proposes even renaming early-stage tumors to something less frightening, such as “acinar neoplasm,” to reduce anxiety and help patients avoid unnecessary interventions. “Men should get PSA testing in midlife with the goal of finding aggressive prostate cancer. If we find low-grade disease along the way…we should not treat it. We just monitor it with active surveillance. If we do that, we can erase this cancer.” His view is echoed by Thai physicians advocating for “active surveillance” approaches—regular monitoring rather than immediate surgery or radiation—for low-risk cases.
This evolution reflects a more sophisticated, evidence-based understanding: not all prostate cancers require aggressive treatment. Dr. Tyler Seibert, a radiation oncologist, highlights that a new era of prostate cancer screening has arrived. Instead of automatically following an elevated PSA with biopsy, many international and Thai doctors now recommend further evaluation with MRI, followed by observation when the cancer is low-risk. For most men, Dr. Seibert says, this approach allows them to “just carry on with their life.” Yet, periodic blood tests and the possibility of eventual treatment can provoke anxiety, a reality acknowledged by doctors everywhere, including those at major Thai cancer centers.
For Thailand, these lessons are timely. The country’s population is rapidly aging, and the number of new prostate cancer cases is steadily increasing, according to data from the National Cancer Institute of Thailand. However, awareness remains low compared to high-profile cancers like breast or colorectal cancer. Prostate-specific antigen tests are now available at most public hospitals, but uptake is still limited by concerns about cost, access in rural areas, and lingering misconceptions about prostate cancer as a “Western” disease. Culturally, taboos around speaking about male sexual and urinary health also hinder men from seeking early advice or screening.
Looking forward, ongoing research into genetic risk factors, the development of new biomarkers, and the increasing availability of prostate MRI promise to further refine how Thai men—and men worldwide—are screened and treated. Several Thai hospitals are already piloting these approaches. The future might see more personalized screening regimes, where age, family history, ethnic background, and biological characteristics all shape when and how often men should be tested.
In the meantime, the best advice for Thai readers is practical and grounded: Men aged 55 to 69 should discuss the pros and cons of PSA testing with a trusted healthcare provider, especially if they have a family history of prostate cancer or other risk factors. Men over 70 typically do not benefit from routine screening and should avoid unnecessary testing. Importantly, a diagnosis of low-risk prostate cancer is not an automatic reason for alarm or to rush into aggressive treatment; modern “active surveillance” is a safe and accepted strategy. Family support, cultural openness in discussing men’s health, and regular consultation with medical professionals are essential as Thailand confronts its prostate cancer challenge.
For more information, the original NPR article can be found here. Additional Thai-specific cancer statistics and guidelines can be accessed via the National Cancer Institute of Thailand and the most recent WHO Cancer Country Profile for Thailand.