Prostate cancer is treatable when caught early, leading to an emphasis on screening. Yet different organizations recommend being screened at different ages, which can lead to some confusion. About 1 in 9 men will be diagnosed with prostate cancer during their lifetime, so understanding one's level of risk is crucial.
What age should men be screened for prostate cancer?
The Prostate Cancer Foundation recommends that Black men or men with a family history of cancer be screened at the age of 40; otherwise, the organization advises getting screened at 45. The American Cancer Society recommends that men at "average risk" be screened at the age of 50, while "men at high risk of developing prostate cancer" like Black men and men who have a first-degree relative, like a father or brother, who were diagnosed with prostate cancer before the age of 65, be screened at 45. Men at "even higher risk" should be screened at 40.
In 2018, the U.S. Preventive Services Task Force issued a recommendation advising men to start talking about screenings with their doctors at the age of 55.
Dr. Behfar Ehdaie, a urologic surgeon specializing in prostate cancer at Memorial Sloan Kettering Cancer Center in New York, said that these varying guidelines are due to the different risk factors that each person faces. Things like family history, environmental factors, race and more can all come into play when it comes to assessing prostate cancer risk.
"There are specific patient level factors that have to go into that decision, including family history, comorbidities, and life expectancy," said Ehdaie, who said that people who are not expected to live more than another decade may not be advised to get screened. "And of course, the patient's own preferences are taken into account, their goals, what they want to achieve."
Dr. Matthew Rettig, the medical director of the Prostate Cancer Program at the Institute of Urologic Oncology at UCLA in California, said that even if screenings aren't performed right away, men should at least start talking about them with their doctors early in life.
"I think I would have that conversation fairly early on in life, maybe even in (your) 30s or 40s, about when to initiate screening," said Retting. "I think that would be most important for patients who are at high risk for prostate cancer and high risk for early onset of prostate cancer. Those are the types of patients that probably ought to have the discussion and make a decision about when to start screening at a relatively young age."
Rettig said that someone who has a "strong family history" of early onset prostate cancer might want to talk to their primary care provider or other health care practitioner earlier in life, while someone with less risk might prefer to wait.
The guidelines for how often men should be screened again also vary. If you have a high prostate-specific antigen (PSA), a protein made by cells in the prostate gland, you may be recommended to come back for more frequent screenings, but those with lower PSA levels might only be advised to come back every four years or so.
"If you're 55 and have you have a PSA of less than one, you can wait four years to get screened again," Rettig explained. "Alternatively, if you're 45 and have a PSA of two and a half, that might be someone who might get a biopsy or be re-screened within the year. ... How frequently one would be prescreened is really contingent upon the specifics of the patient."
What is a prostate cancer screening like?
A prostate cancer screening can be conducted in one of two ways. The first, a PSA test, is a simple blood draw. The second is a brief rectal exam that takes less than 30 seconds to perform.
"For a screening, if a patient comes and asks for a prostate cancer screening, it begins with a blood test," said Ehdaie. "It's a small vial of blood, and then a medical history and physical examination. In the physical examination there will be a digital rectal examination in which the physician's finger is inserted into the rectum to feel the prostate."
This examination lasts "15 to 20 seconds," according to Ehdaie, and is "uncomfortable" but "not painful." Rettig noted that on its own, the digital exam is "not going to add very much," but can be paired with the blood test to give a full picture of the patient's health situation.
After that exam is completed and the bloodwork is done, the results are "evaluated together."
"A decision would be made to either pursue further tests because the screenings suggest there may be something that would be of concern, or they would return at the next scheduled (screening)," Ehdaie said.