Beginning at about age 45 (age 40 if you are Black or have a strong family history of prostate or other cancers), all men should talk to their doctor about screening for prostate cancer. Routine screening starts with a PSA blood test and may include a rectal exam—both are simple and relatively painless.
The PSA Test
Prostate cancer screening starts with a PSA test. This is a blood test, and if your doctor is already drawing blood for other tests, the PSA test order can be added. Results should be back within a few days.
The PSA test measures the level of prostate-specific antigen in your blood. PSA is a protein produced by the prostate, and a small amount is normally released into the bloodstream. When there’s a problem with the prostate, more PSA is released. A rising PSA can be one of the first signs of prostate cancer, though there are other factors that can also cause higher PSA levels. A PSA level above 3 ng/mL may suggest the need for further testing.
In evaluating the results of your PSA test, your doctor will consider:
- Your age
- Your prostate size
- The results of your previous PSA tests
- Other medical conditions, such as BPH or prostatitis
- Whether you’ve taken any medications that may artificially lower PSA, such as finasteride (Proscar or Propecia) or dutasteride (Avodart)
- A history of infections and procedures involving the urinary tract that can elevate the PSA
Your doctor may determine that a digital rectal exam (DRE) is useful in evaluating your prostate health. The prostate is just in front of the rectum. For this test, your doctor will gently insert a lubricated, gloved finger into your rectum to examine the prostate for irregularities in size, shape, and texture. The test is quite brief, and it might be uncomfortable, but it should not be painful.
Your Test Results
Prostate enlargement and mildly increased PSA levels can be a normal part of the aging process, or they could indicate that prostate cancer has begun to develop. Your doctor will take into account your particular situation—including your age, race, and family cancer history—all of which can influence your likelihood of developing prostate cancer.
Learn more about the risk factors for prostate cancer.
If your prostate isn’t enlarged and your PSA level is within normal range, your doctor will likely suggest repeating the tests at regular intervals of 1-2 years as part of your normal checkups. Talk to your doctor about the best course of a personalized prostate cancer screening plan.
If your prostate shows signs of enlargement or irregularity, or your PSA level comes back a little high, your doctor may suggest repeating the tests after an interval of time to see if your prostate has changed further or your level is on the rise–an indication of a potential problem.
There are many reasons why a man’s prostate may be enlarged–the presence of cancer is only one. So, even if your doctor finds something unusual, it may not mean that you have prostate cancer. The next steps could include repeating the tests, performing an ultrasound or MRI of your prostate, or a prostate biopsy. There are newer blood and urine tests that can be used to help determine if a biopsy is needed.
Want more information? Download or order a print copy of the Prostate Cancer Patient Guide.