Prostate Cancer Screenings

What is a prostate cancer screening?

A prostate cancer screening is a test that identifies prostate cancer early, when the condition is easier to treat.

Prostate cancer is the second most common cancer in men, behind skin cancer. Just over 10% of men in the United States will be diagnosed with the condition in their lifetimes. Prostate cancer can be a very slow-growing condition, and men who have it may live for many years without developing symptoms or serious complications. In some men, however, the condition can be aggressive.

If you’re concerned about your risk, talk to your primary care provider about the pros and cons of screening for prostate cancer.

Types of prostate cancer screening

There are two types of prostate cancer tests—prostate-specific antigen (PSA) tests and the digital rectal exam. Your doctor may use either test based on your prostate cancer risk, symptoms and other factors.

Digital rectal exams (DREs)

DREs are physical tests for prostate cancer in which your doctor inserts a gloved, lubricated finger into your rectum and feels for lumps or other abnormalities in your prostate. DREs aren’t as good at identifying prostate cancer as PSA tests, and the U.S. Preventive Services Task Force does not recommend them to screen for the condition. However, your doctor may perform one if your PSA test results are normal and they still suspect you have prostate cancer.

Prostate-specific antigen (PSA) tests

PSA screening tests measure levels of PSA, a protein produced by your prostate, in your blood. A high PSA level is one sign you may have prostate cancer. However, high PSA levels can occur as you get older and if you have another noncancerous condition, such as benign prostatic hyperplasia. If you have high PSA levels, your doctor will recommend other tests to confirm a diagnosis.

Prostate cancer screening guidelines

Screening guidelines for prostate cancer are based on your age and your risk for the condition, as well as the benefits and risks of screening. In general, routine prostate screening isn’t recommended for all men. Instead, you should talk to your doctor about whether you need a prostate cancer screening and, if so, when you should begin.

According to the American Cancer Society, you should have that conversation:

At age 50, if you are at average risk and expected to live for at least 10 years
At age 45, if you are at high risk, which means you are Black and have a father or brother (a first-degree relative) who was diagnosed with prostate cancer before age 65
At age 40, if you have more than one first-degree relative diagnosed with prostate cancer before age 65

Risks of prostate cancer screening

Although prostate cancer screening tests can identify cancer early, they can also lead to false-positive results (results that suggest you have cancer when you do not) and overdiagnosis (identifying cancers that do not need treatment). Talking to your doctor about whether you need screening is the best way to decide whether the screening will benefit your long-term health.

False-positive results

Many men with prostate cancer have high PSA levels, but having high PSA levels does not always mean you have cancer. Your age, medications you take, previous medical procedures and other conditions can increase PSA levels, causing a false-positive test result.

A false-positive test may lead to an unnecessary biopsy or other follow-up tests you do not need. A biopsy is a test in which your doctor takes a sample of tissue and sends it to a lab, where it is analyzed for signs of cancer. Biopsies carry a small risk of infection, and they can lead to unnecessary stress and worry if it turns out you do not have cancer. But, it’s important to follow up on any results of high PSA levels.

How to prepare for a prostate cancer screening

Your PSA levels may increase or decrease due to lifestyle factors, such as having sex, medications you take and previous medical treatments. To help ensure your results are as accurate as possible:

Ask about exercise. Some evidence suggests vigorous workouts, particularly cycling, can increase PSA levels.
Discuss previous procedures you have had. Biopsies, surgery to treat BPH and some urinary procedures can influence PSA levels, making them lower or higher than normal.
Do not have sex or masturbate for 24 to 48 hours. Ejaculating can cause a temporary rise in PSA.
Let your doctor know if you had a recent urinary tract infection (UTI). UTIs can increase PSA levels, so you may need to reschedule your test until a few weeks after treatment.
Tell your doctor about all medications and supplements you take. Certain products can impact your test results.

What to expect

PSA testing for prostate cancer involves a simple blood test. Your provider will clean an area of your arm (usually inside your elbow) with rubbing alcohol, then insert a needle into a vein and take a few ounces of blood. Your provider will cover the area with a bandage.

A PSA test takes just a few minutes. After it’s over, your provider sends the blood sample to a lab to measure your PSA levels.

Understanding the results

It may take up to a week to get the results of your prostate cancer screening PSA test.

There is no concrete definition of “high” and “normal” PSA levels. A PSA level over 10 nanograms per milliliter (ng/mL) is an indicator that you may have prostate cancer, but even at that level, your prostate cancer may not need treatment.

Your provider will review the results and help you understand if your PSA levels are normal or elevated. If your provider feels your PSA levels are too high, they may recommend any of the following tests to see if you have prostate cancer:

A digital rectal exam (DRE): Your provider may perform a physical exam to feel for lumps on your prostate.
A follow-up PSA test: Your provider may want to see if another test shows the same results.
Imaging tests: An MRI scan or transrectal ultrasound helps your provider get a better view of your prostate.
Observation: Your provider may ask you to come back for regular visits so they can repeat PSA cancer testing or perform a DRE and monitor the results for changes over time.
A prostate biopsy: A sample of prostate tissue is taken and examined for the presence of cancer cells.

What is a prostate cancer screening?