WHAT EVERY MAN NEEDS TO KNOW ABOUT SCREENING
For many men, prostate cancer isn’t something they think about until a friend is diagnosed or their doctor mentions getting a PSA blood test.
That may be a mistake.
Prostate cancer is the second most common cancer in men, behind only skin cancer. In the United States, about 1 in 8 men will be diagnosed during their lifetime. The good news is that when prostate cancer is found early—before it has spread—the five-year survival rate is greater than 99%.
The challenge is that prostate cancer often develops silently, without causing any symptoms until it is more advanced.
That is why understanding your personal risk and knowing when to be screened are so important.
What Is the Prostate?
The prostate is a walnut-sized gland located just below the bladder. It surrounds part of the urethra, the tube that carries urine out of the body.
Its primary job is to produce fluid that nourishes and transports sperm.
As men age, the prostate commonly enlarges. Most enlargement is due to benign prostatic hyperplasia (BPH), which is not cancer. However, prostate cancer can also develop within the gland, making proper evaluation essential.
Who Is Most at Risk?
Several factors increase the likelihood of developing prostate cancer.
Age
Age is the single biggest risk factor.
Most prostate cancers are diagnosed after age 65.
Although younger men can develop prostate cancer, it is uncommon before age 50.
As life expectancy increases, more men are living long enough to develop prostate cancer, making screening discussions especially important.
Family History
If your father, brother, or son has had prostate cancer, your own risk increases significantly.
Your risk becomes even higher if:
- More than one close relative has had prostate cancer
- Family members were diagnosed before age 65
- Multiple generations have been affected
Family history is one of the strongest reasons to begin screening earlier.
African American Men
African American men have one of the highest prostate cancer risks in the world.
Compared with White men, they are:
- More likely to develop prostate cancer
- More likely to develop aggressive disease
- More likely to die from prostate cancer
For this reason, many experts recommend discussing screening earlier in African American men.
Inherited Genetic Mutations
Certain inherited gene mutations increase prostate cancer risk.
These include mutations in:
- BRCA1
- BRCA2
- HOXB13
- Lynch syndrome-associated genes
Men who have a strong family history of breast, ovarian, pancreatic, or prostate cancer should discuss whether genetic counseling or testing may be appropriate.
Lifestyle
Unlike some cancers, lifestyle is not the primary driver of prostate cancer, but it still matters.
Research suggests possible associations with:
- Obesity
- Physical inactivity
- Diets high in processed meat
- Diets high in saturated fat
Conversely, maintaining a healthy weight, exercising regularly, and eating a Mediterranean-style diet are associated with better overall health and may help reduce the risk of aggressive disease.
Does Prostate Cancer Cause Symptoms?
Often, no.
Many men with early prostate cancer feel completely healthy.
When symptoms occur, they may include:
- Difficulty urinating
- Weak urine stream
- Frequent nighttime urination
- Blood in the urine
- Blood in the semen
- Erectile dysfunction
- Bone pain (with advanced disease)
Unfortunately, these symptoms are much more commonly caused by benign prostate enlargement, not cancer.
That is why screening—not waiting for symptoms—is so important.
What Is a PSA Test?
PSA stands for prostate-specific antigen, a protein made by prostate cells.
A PSA blood test measures how much PSA is circulating in your bloodstream.
Higher PSA levels can occur because of:
- Prostate cancer
- Enlarged prostate (BPH)
- Prostate infection
- Recent ejaculation
- Certain medical procedures involving the prostate
An elevated PSA does not automatically mean cancer, but it does signal that further evaluation may be needed.
One of the biggest advances over the past decade has been moving away from relying on a single PSA number. Today, physicians often consider:
- Your age
- PSA trend over time
- PSA density (PSA relative to prostate size)
- PSA velocity (how quickly it changes)
- Additional blood or urine biomarkers
- MRI findings before deciding on a biopsy
This approach has helped reduce unnecessary biopsies while improving detection of clinically significant cancers.
What About the Digital Rectal Exam?
The digital rectal exam (DRE) allows a physician to feel the back surface of the prostate for abnormalities.
Although it may be briefly uncomfortable, it usually takes less than a minute.
The DRE can sometimes detect cancers that produce little PSA, making it a useful part of the evaluation in selected men.
When Should Screening Begin?
Current recommendations emphasize shared decision-making between a man and his healthcare provider.
General guidance includes:
- Average risk: Begin discussing screening around age 50.
- Higher risk (African American men or men with a first-degree relative diagnosed early): Consider discussions beginning around 45.
- Very high risk (multiple affected relatives or known genetic mutations): Discussions may begin around 40.
Screening decisions should also take overall health and life expectancy into account. Men with a life expectancy of less than about 10 years are generally less likely to benefit from routine screening because many prostate cancers grow very slowly.
Are There Any Downsides to Screening?
Yes.
Screening saves lives, but it is not perfect.
Possible downsides include:
- False-positive PSA results
- Anxiety
- Additional testing
- Unnecessary biopsies
- Detection of slow-growing cancers that may never become life-threatening
Fortunately, modern prostate cancer care has changed dramatically.
Instead of treating every cancer immediately, many men with low-risk disease are safely managed with active surveillance, avoiding unnecessary surgery or radiation while closely monitoring for changes.
We’ll discuss this approach in detail in our next article.
Can You Lower Your Risk?
No one can completely prevent prostate cancer, but healthy habits may lower the risk of developing aggressive disease while improving your overall health.
Focus on:
- Maintaining a healthy weight
- Exercising most days of the week
- Eating plenty of fruits and vegetables
- Limiting processed meats
- Not smoking
- Keeping chronic conditions such as diabetes and high blood pressure under control
These habits also reduce your risk of heart disease, stroke, and many other chronic illnesses.
Research Snapshot
Large randomized trials have shown that PSA-based screening can reduce deaths from prostate cancer when men are appropriately selected and followed. More recent advances—including prostate MRI, improved biomarkers, and active surveillance—have reduced unnecessary biopsies and overtreatment while maintaining the benefits of early detection.
Dr. Mike’s Prescription
If you’re over 50—or over 45 with higher risk—don’t wait until you develop urinary symptoms to think about prostate cancer.
Have a conversation with your healthcare provider about your individual risk and whether screening makes sense for you. Early detection doesn’t mean every man needs treatment, but it does provide more options and, when needed, a much better chance of cure.
Did You Know?
A healthy PSA level does not guarantee you don’t have prostate cancer, and a high PSA level does not necessarily mean you do. That’s why PSA results should always be interpreted in the context of your age, risk factors, physical examination, and, when appropriate, additional testing such as MRI or specialized biomarkers.
Bottom Line
Prostate cancer is common, but it is also one of the most treatable cancers when detected early. Knowing your personal risk factors and having an informed discussion about screening can help you make the decision that is right for you. For many men, a simple blood test may be the first step toward protecting their long-term health.