Screen Smarter: What Every Man Should Know About Prostate Cancer Early Detection
Should I or shouldn’t I? That’s the question many men face when it comes to prostate cancer screening. The goal of early detection is to understand a man’s risk so he and his healthcare provider can make informed decisions together.
Early detection begins with a PSA blood test. PCEC recommends that every man age 45 and older should know his baseline PSA. A digital rectal exam (DRE) is optional and is generally recommended only if PSA is elevated or symptoms are present.
"Despite the limitations, early detection remains the best available tool for spotting early signs of prostate cancer,” said E. David Crawford, President of the Prostate Conditions Education Council.
Here are key facts to know about prostate cancer early detection:
1. Early Detection Is Not a Diagnosis
A PSA blood test helps estimate a man’s risk of having prostate cancer. PSA can be elevated for many reasons, including benign prostate conditions. An abnormal result does not automatically mean cancer. It means follow up is needed to understand what is driving the change.
2. Know Your Baseline PSA at Age 45
PCEC recommends a baseline PSA blood test beginning at age 45. This baseline helps guide future monitoring and next steps. Early detection may not be beneficial for all men, so decisions should be personalized based on overall health and risk factors.
3. PCEC PSA Monitoring Guidance
After you get your baseline PSA, PCEC recommends follow up based on the result:
PSA less than 1.5 ng/mL
Most men are considered low risk. Repeat PSA every 2 to 4 years, unless other risk factors are present.
PSA 1.5 ng/mL or higher
This does not mean cancer, but it may indicate a prostate health condition. Follow up with a repeat PSA and discuss next steps with a healthcare provider.
DRE if performed and abnormal
Follow up evaluation with a healthcare provider is recommended.
4. Who Is at Higher Risk
Some men may benefit from closer attention and earlier follow up because risk is higher. Higher risk groups can include:
- Age: Risk increases with age, especially over age 65.
- Race: Black or African American men are about twice as likely to be diagnosed with and die from prostate cancer.
- Family history: A close relative with prostate, breast, ovarian, colorectal, pancreatic, or endometrial cancer, especially if diagnosed before age 60.
- Genetics: Inherited mutations such as BRCA1, BRCA2, HOXB13, ATM, and others.
- Occupational exposures: Jobs with increased chemical or carcinogen exposure. Examples can include firefighters, veterans, first responders, pilots, and agricultural workers.
5. Life Expectancy Matters
PCEC does not recommend early detection in men who have a decreased life expectancy due to other serious health issues and have no signs of prostate cancer or other prostate conditions.
6. Abnormal PSA Does Not Always Mean You Need a Biopsy Right Away
PCEC supports further risk stratification in men with abnormal PSA results. This can include blood, urine, and tissue based genomic markers, and other tools to better understand risk, guide diagnosis, and inform treatment decisions.
7. Think Bigger Than Just PSA
PCEC encourages a complete men’s health evaluation. This may include testing for PSA, testosterone, triglycerides, cholesterol (HDL and LDL), and glucose, as well as newer prostate cancer biomarkers and imaging tools when appropriate and available.
"Early detection identifies a man’s risk for prostate cancer. It does not diagnose the disease. The most important step is to know your baseline PSA and then make an informed plan with your healthcare provider,” said E. David Crawford, President of PCEC.