Prostate cancer is one of the most common cancers among men, but it may not cause noticeable symptoms in its early stages. Screening can help identify changes that may require additional evaluation, often before symptoms develop.
Updated guidance from the American Urological Association and Society of Urologic Oncology (AUA/SUO) emphasizes a more personalized approach to prostate cancer screening. Rather than following the same schedule for everyone, patients and their healthcare providers are encouraged to make screening decisions based on age, individual risk factors, overall health, and personal preferences.
When should prostate cancer screening begin?
The AUA/SUO guideline recommends discussing a baseline prostate-specific antigen (PSA) test between ages 45 and 50 for people at average risk.
Those at increased risk may benefit from beginning the conversation between ages 40 and 45. Risk factors can include:
- African-American ancestry
- A strong family history of prostate cancer
- Certain inherited genetic mutations associated with prostate cancer
- Multiple risk factors that may increase the likelihood of developing the disease
- Screening decisions should be made through a conversation with a healthcare provider who can help patients understand their individual risk.
What is a PSA test?
A PSA test is a simple blood test that measures the level of prostate-specific antigen in the blood. An elevated PSA level does not necessarily mean that someone has prostate cancer. PSA levels may also increase because of an enlarged prostate, inflammation, infection, age, or other noncancerous conditions.
Under the updated guidance, PSA remains the recommended first-line screening test. A digital rectal examination, is no longer considered a required first step in routine screening. However, a provider may still recommend one in certain circumstances.
Does screening need to happen every year?
Not necessarily. For many patients, screening every two to four years may be appropriate.
The timing can be adjusted based on:
- PSA results
- Age and individual risk factors
- Overall health
- Family and genetic history
- Previous screening findings
- Personal preferences
Life expectancy
Patients with higher PSA levels or additional risk factors may need more frequent monitoring. Others may be able to safely wait longer between tests.
What happens if a PSA result is elevated?
An elevated PSA result does not automatically mean that a biopsy is needed, or that cancer is present. A healthcare provider may first recommend repeating the PSA test to confirm the result.
If further evaluation is appropriate, clinicians can now use several tools to better understand a patient’s risk, including:
- Risk assessment calculators
- Blood- or urine-based biomarker tests
- Multiparametric MRI
- Prostate biopsy, when clinically appropriate
MRI is particularly useful for patients who previously had a negative biopsy but continue to have findings that warrant evaluation. These tools can help clinicians identify cancers that may require treatment while reducing unnecessary procedures and the detection of cancers unlikely to cause harm.
Start the Conversation
Prostate Cancer Awareness Month is an important reminder to understand your risk and discuss screening with a healthcare provider. Your primary care provider or urologist can help you make an informed screening decision based on your age, health history, and individual risk factors.
For primary care services:
Solara Health
Call: 732-724-3070
Visit: solarahealthnj.com
For specialized urologic care:
Astera Urology
Call: 973-927-5788
Visit: asteraurology.org