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Screening and Early Detection
Last Reviewed: June 03, 2021

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. But there is no one-size-fits-all approach to prostate cancer screening.

When should you start screening?

First, talk to your doctor at your next checkup to go over your particular risk factors. You may have more than one risk factor at play and thus have a greater chance of developing prostate cancer than other men.

In general, discussions with your doctor about screening for prostate cancer should begin in your 40s. Here are some rough guidelines:

Do you have family history of prostate,
ovarian, breast, colon, or pancreatic 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 more about how your age, race, and other factors may affect your prostate cancer risk.


How do I get screened?

The “gold-standard” test for prostate cancer screening is the PSA (prostate specific antigen) test.

The PSA test measures levels of prostate-specific antigen in the blood. PSA is a protein produced by the cells of the prostate. Because cancerous cells tend to produce more PSA, a spike in your PSA level may signify a problem, however, there are other benign conditions that may cause an uptick in PSA. Read more here about how to make sure your PSA test is as accurate as possible. If you’re having a PSA test, it can often be added on to other blood work you may be having that day, and you may not need a separate blood draw.

Tracking your PSA over time can be valuable to distinguish a temporary increase (e.g., due to an infection) from a gradual, yet persistent rise. Even if your level is still within normal range, but is higher than it was the last time it was tested, it’s worth checking further. After a single high PSA result, often the first step is to repeat the test a couple of weeks later to confirm that it is, in fact, elevated. This should be done at the same lab as the previous test, to avoid fluctuations due to different equipment.

What happens next?

Subsequent to PSA screening, depending on your results, your doctor may recommend follow-up tests and/or a biopsy. There are many other supplementary tests and considerations that can help you and your doctor decide if a biopsy is necessary, including:

 

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  • Digital rectal exam (DRE)
  • Free PSA test (<10% Free PSA indicates greater risk of having cancer; <25% is concerning)
  • PSA velocity or the rate of rise over time (faster increase means more risk)
  • PSA density = PSA per volume of prostate (higher density means more risk)
  • PSA-based markers (e.g., Prostate Health Index, 4K score)
  • Other markers, e.g., urinary PCA3 or Select MDx text
  • MRI of the prostate

The DRE, or digital rectal exam, may also be used as a baseline test along with the PSA test, though is not recommended as a screening test by itself. Your doctor will insert a gloved, lubricated finger into your rectum and press toward the front of your body to feel the prostate. A prostate that’s enlarged or irregularly shaped, or bigger than it was at your previous exam, is a red flag that should be investigated.

Are there any other tests I should have as part of my screening routine?

Better cancer-specific blood- and urine-based tests are on the horizon, as well as options for using imaging, such as MRI, to help screen and target the biopsy for prostate cancer. However, at this time they do not replace the PSA for screening and early detection.

How is the PSA used after diagnosis?

PSA is the primary tool for screening—that is, testing of healthy men without symptoms. Once the diagnosis of prostate cancer is confirmed by biopsy, PSA is also routinely used for risk assessment, active surveillance in men with low-risk cancer who elect this approach, and post-treatment monitoring. Your doctor will use the PSA test as one of many guides to indicate whether treatment is working and, down the line, whether the cancer recurs.


Learn more about how prostate cancer is diagnosed.


Are You at Risk for Prostate Cancer?

Take this quiz to find out when you should start screening.

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