Screening for Prostate Cancer
What is Prostate Cancer Screening?
Prostate cancer often has no symptoms until the disease is advanced, and screening may help detect cancer early, when the chances of treatment success are high. Screening starts with a simple blood test. The level of a protein in the blood called prostate specific antigen (PSA) is measured.
When Should I Start Screening?
PCF recommends starting discussions with your doctor about screening for prostate cancer in your 40s. You may have more than one risk factor at play and thus have a greater chance of developing prostate cancer than other men.
Use this chart to understand when to start the conversation with your doctor about PSA screening or take the online quiz.
| Do you have family history of prostate, ovarian, breast, colon, pancreatic, or multiple other cancers, or do you know that gene mutations (such as BRCA) are present in your family? | Discuss screening with your doctor starting around age 40. |
| Are you Black? | Discuss screening with your doctor starting around age 40. |
| How old are you? | In the absence of other risk factors, discuss screening with your doctor starting at around age 45. |
Learn about the PCF Screening Guidelines for Black Men in the U.S.
What is PSA?
PSA, or Prostate Specific Antigen, is a protein produced by the prostate and found mostly in the semen, with very small amounts released into the bloodstream. It is used as a “disease marker” to represent prostate cancer. When there’s a problem with the prostate—such as the development and growth of prostate cancer—more PSA can be released. PSA eventually reaches a level where it can be easily detected in the blood. This can be the first indicator of prostate cancer.
How Do I Get Screened?
First, talk to your doctor about the risks and benefits of screening. The “gold-standard” test for prostate cancer screening is the PSA (prostate specific antigen) test. During a PSA test, a small amount of blood is is drawn from a vein (usually in the arm) and the level of PSA is measured.
After your PSA test, your health care provider may perform a digital rectal exam (DRE), in which a gloved, lubricated finger is inserted into the rectum to examine the prostate for any irregularities in size, shape, and texture, as well as assess for tenderness. Note that the DRE cannot feel prostate abnormalities in the anterior (forward) area of the prostate, away from the rectum, and is often most useful only when the prostate cancer has grown sufficiently to cause cancer that can be felt with a finger. The DRE is no longer recommended as a standalone screening test for prostate cancer.
What Does My PSA Level Mean?
Doctors look at the PSA level over time, comparing with prior test results, and consider whether there could be another, benign explanation (such as prostate inflammation, benign prostate enlargement, or a urinary tract infection) for a rising PSA. As the PSA number goes up, the chance that cancer is present increases.
Men whose levels are confirmed to be above 4 ng/mL are often recommended to undergo further testing in the form of imaging and/or blood or urine tests, often with a prostate biopsy. However, this PSA “cutoff” does not mean that prostate cancer is definitely present, and, conversely, some cancers may be present even when levels are lower, particularly among younger men. It is important to highlight that the PSA test in this setting is a screening, not a diagnostic, test. Your physician will need to perform a diagnostic prostate biopsy to confirm the presence or absence of prostate cancer.
When Should I Stop Screening?
Once you are over about 70 years of age, some medical guidelines recommend you stop screening, with the rationale that the potential benefits do not outweigh the harms. Why? Many cases of prostate cancer are very slow-growing, and treatments can be taxing. Statistically, older men are more likely to die of other causes, even when they have prostate cancer. However, if you are a healthy man over 70, the Prostate Cancer Foundation recommends that you continue to discuss screening with your doctor. The decision about whether to screen past age 70 should be made on an individual basis.
The bottom line is that it is never hurts to talk with your doctor about screening. The ultimate goal is to catch aggressive, higher-risk cancer early so it can be successfully treated, to give you the longest, healthiest life possible. Low-risk cancers can be carefully monitored, such that treatment is deferred to only if and when it is needed.
