Prostate cancer often has no symptoms — should you be screened?
When it comes to preventing cancer, early detection can make a meaningful difference. But prostate cancer screening isn't as straightforward as it once seemed. In recent years, leading medical organizations have updated their guidance, shifting away from routine screening for all men and toward a more personalized, informed approach.
So how do you know if prostate cancer screening is right for you?
Prostate cancer screening: when should men be screened?
Prostate cancer often develops slowly and may not cause symptoms in its early stages. That's why screening can be an important tool — but only when it's used thoughtfully.
The U.S. Preventive Services Task Force (USPSTF) recommends that men 55 to 69 years old make an individual decision about prostate cancer screening after discussing the potential benefits and risks with their physician. Rather than recommending routine screening for everyone, experts emphasize shared decision-making, taking personal health and preferences into account.
"Prostate cancer screening isn't one-size-fits-all," explains Christopher Hartman, MD, MBA, medical director of urology at Main Line Health. "For many men, especially those in their mid-50s to late 60s, the most important step is having an informed conversation with their doctor about personal risk factors and overall health."
For most men aged 70 and older, routine prostate cancer screening is generally not recommended, as the potential harms may outweigh the benefits.
Who should consider screening earlier?
According to the American Urological Association, some men may benefit from talking to their doctor about prostate cancer screening before age 55, particularly those at higher risk.
This includes men who:
- Have a family history of prostate cancer
- Are of African ancestry, which is associated with higher rates of prostate cancer and more aggressive disease
- Have certain genetic or health factors that increase risk
"Age is important, but it's only part of the picture," says Dr. Hartman. "Family history, race, overall health and even baseline PSA levels all help guide whether screening makes sense for you — and how often testing should be done."
Understanding prostate cancer screening tests
If you and your physician decide screening is appropriate, there are two commonly used tests to help evaluate prostate health.
Prostate-specific antigen (PSA) test
A PSA test is a simple blood test that measures the level of prostate-specific antigen in the blood. Higher PSA levels can be associated with prostate cancer, but they can also be caused by noncancerous conditions such as an enlarged prostate, inflammation, infection or certain medications.
'An elevated PSA doesn't automatically mean prostate cancer," Dr. Hartman explains. "Just as an abnormal mammogram doesn't always mean breast cancer, a higher PSA level often leads to additional evaluation — not immediate treatment."
Digital rectal exam (DRE)
A digital rectal exam may also be performed during a routine physical or if there are symptoms of concern. During this exam, a physician checks the prostate for abnormalities in size, shape or texture.
If PSA levels remain elevated over time or if other concerning findings are present, your doctor may recommend further testing, such as imaging or a biopsy.
Not all prostate cancers require immediate treatment
One important reason screening recommendations have evolved is a better understanding of prostate cancer behavior. Many prostate cancers grow very slowly and may never cause symptoms or affect life expectancy.
"In some cases, we may recommend active surveillance rather than immediate treatment," says Dr. Hartman. "That means closely monitoring the cancer over time and intervening only if there are signs it's becoming more aggressive."
This approach helps reduce unnecessary treatments and lowers the risk of side effects such as urinary incontinence or sexual dysfunction.
Why the conversation matters
Prostate cancer screening can help detect aggressive cancers early when they're most treatable. At the same time, screening can lead to false positives, anxiety, additional testing, or treatments that may not ultimately be needed.
"That's why shared decision-making is so important," Dr. Hartman says. "Our goal is to help men understand both the potential benefits and the tradeoffs, so they can make a choice that aligns with their health goals and values."
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