Prostate cancer is one of the most common cancers affecting men, but not every man has the same level of risk. Age, family history, race, genetics, and other factors can all play a role.
Prostate cancer often does not cause noticeable symptoms in its early stages, which is why screening can find some cancers before symptoms appear. Screening also does not look the same for every man. Here are seven questions to bring to your next appointment.
1. When Should I Start Talking About Prostate Cancer Screening?
There is no single age when every man should begin screening. The American Urological Association recommends shared decision-making and says clinicians may offer a baseline PSA test between ages 45 and 50. Family history and race can also influence screening decisions.
Men at higher-than-average risk may need to start the conversation earlier, including those with a family history, certain inherited genetic mutations, and Black men, who have a higher risk of developing and dying from prostate cancer.
2. Does Prostate Cancer Run in My Family?
Having a father, brother or son who has had prostate cancer can increase your risk. Risk may be higher when a relative was diagnosed at a younger age or multiple relatives have had prostate cancer.
Other cancers in your family, including breast, ovarian, and pancreatic cancers, may also provide clues about your risk. Ask relatives about who had cancer, what type, and how old they were at diagnosis.
3. Does My PSA Need to Be Checked?
PSA, or prostate-specific antigen, is a protein produced by prostate cells. A PSA test measures the amount in your blood and is commonly used as the first screening test when screening is appropriate.
A PSA result is only one piece of the picture. PSA can be affected by prostate cancer, benign prostate enlargement, inflammation, infection and other factors. Your provider may consider your PSA along with your age, family history, race, genetics and previous results.
4. What Does an Elevated PSA Mean?
An elevated PSA does not automatically mean you have prostate cancer. Benign prostate enlargement, prostatitis and certain urinary problems can also raise PSA.
The AUA recommends repeating a newly elevated PSA before moving on to biomarkers, imaging or biopsy. Depending on your results, your provider may repeat the test, review previous PSA levels, consider other risk factors, recommend additional testing or discuss imaging or biopsy. One abnormal result does not necessarily mean something is wrong, so ask what it means in the context of your overall risk.
5. Do I Need an MRI or Biopsy?
An elevated PSA does not automatically mean a biopsy is needed. If concern remains, a prostate MRI may help identify areas that look suspicious for cancer and guide decisions about biopsy.
A biopsy involves taking small samples of prostate tissue for examination under a microscope and is used to confirm whether cancer is present. Your urologist will consider your PSA, medical and family history, imaging, and other findings when deciding what comes next.
6. Should I Consider Genetic Testing?
Certain inherited genetic changes, including BRCA2, MSH2 and HOXB13, can increase prostate cancer risk. Genetic testing may be worth discussing if you have a strong family history, multiple relatives with prostate or related cancers, younger-age cancer diagnoses, or a history suggesting an inherited cancer syndrome.
A healthcare provider or genetic counselor can help determine whether testing makes sense and explain the results.
7. How Often Should I Be Screened?
Screening intervals can vary based on age, PSA level, family history, race, genetic risk, previous screening results, and overall health and life expectancy. A baseline PSA can give your provider a starting point for future monitoring. Follow-up should be based on your risk and health rather than assuming one normal result means you are finished with screening.
Know Your Risk. Start the Conversation.
There is no single test, age, or PSA level that applies to every man. Family history, age, race, genetics, PSA results and overall health can all help shape screening decisions.
This September, take some time to learn about your prostate cancer risk and talk with your provider about screening. If you have questions about your risk or when to begin screening, talk with a Urology Alliance provider about what makes sense for you.
