Prostate cancer remains the most commonly diagnosed cancer among men, with an estimated 313,780 new cases expected in 2025, according to the National Cancer Institute. Dr. Brian Miles, a urologic oncologist at Houston Methodist Neal Cancer Center, notes that “about 1 in 8 men will develop prostate cancer in their lifetime.”
Screening for prostate cancer does not prevent the disease but can improve treatment outcomes if cancer is detected early. Dr. Miles explains, “The mortality rate of prostate cancer becomes much higher when it’s found late. Caught in the early stages, however, it’s a disease that’s easily treated, easily controlled — though this does mean we need to find it before it’s progressed.”
Early detection through screening allows for intervention before symptoms begin and reduces the likelihood of the cancer spreading or requiring aggressive treatment.
The primary method for screening is the PSA test, which measures levels of prostate specific antigen in the blood. “The most well-known screening test for prostate cancer is called the PSA test,” says Dr. Miles. “PSA stands for prostate specific antigen. It’s a protein produced by the prostate gland.” Elevated PSA levels may indicate a problem with the prostate but do not confirm cancer on their own.
“Elevated PSA doesn’t definitely mean a man has prostate cancer, but it can help determine who we need to screen further,” Dr. Miles adds.
Additional tests such as digital rectal exams and newer blood tests may be used to refine risk assessment before proceeding to biopsy—the definitive diagnostic tool for prostate cancer. “Not every man is going to need screening beyond the PSA test, but these other screening tools we have can help further refine a person’s prostate cancer risk and determine whether biopsy is truly needed to rule out or confirm a diagnosis,” says Dr. Miles.
If recommended by a doctor, biopsy procedures are described as safe and relatively painless despite some discomfort from an ultrasound probe: “Biopsy of prostate is not a big deal,” says Dr. Miles. “There’s really no pain and it’s safe to do, although it’s uncomfortable due to the ultrasound probe.”
Most men are advised to start discussing screening after age 50 since risk increases with age; however, those at higher risk—such as African American men or those with family history—should consider starting earlier screenings around age 40 or 45.
“There are two factors that warrant screening earlier than this,” adds Dr. Miles. “If you’re African American or if you have a family history of prostate cancer, you’re considered higher risk and we recommend you start getting PSA tests done around age 40.”
Screening typically begins during routine check-ups with primary care physicians who can add PSA testing to standard blood panels when appropriate.
“If you’re over age 50 — or younger but have a higher risk for prostate cancer — ask your doctor about PSA testing,” recommends Dr. Miles.
If elevated PSA levels are detected, patients are referred to urologists for follow-up exams including digital rectal examination and possibly more sensitive blood tests targeting related proteins.
“If your PSA is elevated, your doctor will refer you to a urologist for follow-up screening,” says Dr. Miles. “Follow-up includes a digital rectal exam, where we feel the prostate for any abnormality.”
Further action depends on results from these additional assessments; persistent abnormalities may lead to biopsy confirmation while normal findings might only require ongoing monitoring.
“If this blood test is also abnormal, it suggests the person is at higher risk and will need to biopsy,” explains Dr. Miles. “If the result is normal, it suggests they are at lower risk and we can simply monitor their PSA levels each year moving forward.”
Treatment options vary based on severity—from active surveillance of low-grade cancers (“A low-grade, non-aggressive prostate cancer can sometimes simply be watched for quite some time — called active surveillance — before requiring treatment,” says Dr. Miles) to more intensive interventions if necessary.
