Prostate cancer screening: What you need to know

The prostate is a small gland that is part of the male reproductive system. The prostate is located below the bladder and above the rectum. It encircles the urethra, the tube that carries urine out of the body. 

The prostate produces a fluid that combines with sperm and fluids from other glands to create semen. It also helps to control the flow of urine. 

All men are at risk for prostate cancer, and about one in eight men will be diagnosed with prostate cancer during their lifetime. However, there are certain factors that may affect an individual man’s prostate cancer risk. These include:

• Age: The odds of a prostate cancer diagnosis increase rapidly after age 50. About six in 10 prostate cancers are found in men older than 65.
• Race/ethnicity: African American men are more likely to develop and die of prostate cancer than men of other races. Prostate cancer occurs somewhat less often in Asian, Hispanic, and Latino men than in non-Hispanic white men.
• Family history: Men who have a father or brother with prostate cancer are at increased risk. The risk is higher for men with several affected relatives, particularly if those relatives were diagnosed before the age of 50.
• Genetic factors: In addition to family history, certain specific genetic factors are known to increase a man’s risk of prostate cancer. These include:
  • Inherited variants of the BRCA1 or BRCA2 gene, which are linked to an increased risk of breast and ovarian cancers in women. Men who have female relatives with breast or ovarian cancer related to BRCA may be more likely to develop prostate cancer.
  • Lynch syndrome, also known as hereditary non-polyposis colorectal cancer, or HNPCC. Men with Lynch syndrome are at increased risk for prostate cancer.

To screen for prostate cancer, we use a blood test that measures a protein produced by the prostate — prostate-specific antigen (PSA). A “positive PSA test” is one that shows higher-than-normal levels of PSA in the blood. 

But most of the time, a positive PSA test does not mean you have cancer. That’s because there are many other reasons for an enlarged prostate and higher levels of PSA in your blood — a prostate infection, recent sexual activity, even a long bike ride.

If your first PSA test is positive, we’ll repeat the test. We might treat you for a possible infection first. We’ll also ask that you avoid ejaculating or riding a bicycle for at least 48 hours before the second test.

If the second test is also positive, we will refer you to a urologist, who might order further testing. This could include more laboratory tests, an MRI, or a prostate biopsy. To do a prostate biopsy, the lab needs a small sample of prostate tissue, which is obtained with a small needle guided by a rectal ultrasound.

If you are 50–69 years old — or if you are older than 40 and have a higher risk of prostate cancer due to other factors — PSA testing is a question to discuss with your primary care provider (PCP). 

The U.S. Preventive Services Task Force (USPSTF) has found evidence that PSA screening may slightly lower the chance of death from prostate cancer in some men. But USPSTF also notes that many men suffer unnecessary harm as a result of screening. This includes false-positive PSA tests that lead to more invasive testing and diagnoses of cancers that would never cause symptoms or death. 

Before you have that conversation with your PCP, ask yourself these questions: 

• Do I want to know if I have prostate cancer, even if the cancer might never threaten my health?
• If I found out that I had prostate cancer, would I opt to get treatment, knowing that there is a high risk of side effects but only a small chance of living longer?

Deciding whether to undergo PSA testing is a personal choice. Asking these critical questions of yourself can help ensure that you make a decision that aligns with your values and health priorities. When you are ready, have that discussion with your PCP and make an informed choice about whether PSA testing is right for you.