Conflicting opinions exist on the best age for routine prostate cancer screening. Males with an average risk of prostate cancer should discuss beginning screening at age 50. Those with a higher risk may require screening at an earlier age.

The prostate gland is located in front of the rectum and below the bladder in males. Roughly the size of a walnut, it produces some fluid included in semen.

Prostate cancer is the second most common cancer in U.S. males. It grows slowly, and symptoms can appear much later, as cancer has advanced.

This article will outline the screening guidelines for prostate cancer. It will also look at how doctors screen for prostate cancer, the results and next steps, and risks of prostate cancer screening.

Finally, it will briefly look at how much prostate cancer screening costs.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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The American Cancer Society (ACS) states that people should speak with a doctor to make an informed decision about whether they require screening for prostate cancer.

People should not begin screening until they have spoken with a doctor and understand the uncertainties, risks, and benefits of prostate cancer screening.

People should begin the discussion about screening at:

  • age 50 if they have an average risk of prostate cancer and are likely to live for at least 10 years or more
  • age 45 if they have a high risk of prostate cancer, such as:
    • people with a first-degree relative who had a prostate cancer diagnosis before age 65
    • African Americans
  • age 40 if they have an even higher risk of prostate cancer, such as people with a first-degree relative who had a prostate cancer diagnosis at an early age

For those who decide to undergo prostate cancer screening and have approval from a healthcare professional, a doctor will order a prostate-specific antigen (PSA) blood test.

The U.S. Preventive Services Task Force states that males between 55–69 years old should make individual decisions about getting screening with a PSA test.

Males age 70 and above should not get routine screening for prostate cancer.

PSA is a protein that the prostate produces. Although mostly present in semen, small amounts are also present in the blood. More PSA is released when a problem occurs in the prostate.

The National Cancer Institute states that there is no specific normal amount of PSA in the blood. Some doctors consider normal levels of PSA to be 4 nanograms per milliliter (ng/mL) or lower.

According to the ACS:

  • Most males without prostate cancer have PSA levels lower than 4 ng/mL.
  • Males with PSA levels between 4 and 10 have a 25% chance of having prostate cancer.
  • Males with PSA levels above 10 have a 50% chance of having prostate cancer.

If an individual has high levels of PSA, the doctor may recommend another PSA test to back up the finding. However, if the second test is also high, the doctor may recommend continued testing and monitoring unless they find a lump during a digital rectal exam.

If no signs of prostate cancer are detected:

  • A person may get retested every 2 years if the PSA levels were less than 2.5 ng/mL.
  • A person may get retested every year if the PSA levels were 2.5 ng/mL or higher.

A digital rectal examination (DRE) occurs when a doctor places a gloved, lubricated finger into the rectum to feel for an enlarged prostate.

Although less effective than a PSA blood test, it can help detect cancer in people with normal PSA blood test results.

A DRE can be uncomfortable. However, it is not usually painful and does not take very long to perform.

If a test is inconclusive or positive, there are other tests to check for prostate cancer and diagnose its stage, including:

There are many ways to treat prostate cancer, which must be discussed with a doctor upon diagnosis. These include:

  • active surveillance
  • surgery
  • radiation
  • hormone treatment
  • chemotherapy
  • drugs to treat cancers that spread to the bone
  • clinical trials

Prostate cancer screening can help find prostate cancers that have a high risk of spreading, increasing the chance of a person’s outlook.

However, it does carry some risks. The primary risk of prostate cancer screening is that it can cause a false positive test result. False positive results lead to further unnecessary tests, including a biopsy of the prostate.

Many healthcare professionals are willing to work proactively to rule out unnecessary tests.

In many states, there are laws that require private health insurers to cover tests that detect prostate cancer screening, including the DRE and PSA test.

However, laws can vary from state to state. It is important that people check with their insurer to find out what they cover.

Medicare Part B covers DREs and PSA blood tests every 12 months for men over age 50.

For a DRE, a person will have to pay 20% of the deductible, but a person does not need to pay anything for the PSA blood test.

Many healthcare professionals and organizations do not recommend routine screening for prostate cancer.

A person needs to speak with a healthcare professional about the risks and benefits of prostate cancer screening. This discussion should take place at the age of:

  • 50 for those with an average risk of prostate cancer
  • 45 for those with a high risk of prostate cancer
  • 40 for those with an even higher risk of prostate cancer

If a person wishes to undergo screening and a doctor approves, they will have a PSA blood test. They may also get a DRE.