Prostate cancer is one of the most common cancers in men. Many prostate cancers grow slowly and may never cause symptoms or shorten a person's life, while others can be aggressive and potentially life-threatening. Screening is designed to identify clinically important prostate cancer before symptoms develop.
 

PSA Blood Test
 

Prostate-specific antigen (PSA) is a protein produced by prostate tissue. A PSA blood test measures its concentration in the blood.

An elevated PSA does not necessarily mean prostate cancer is present. PSA can also increase because of:

• Benign prostatic hyperplasia (BPH)

• Prostatitis or urinary infection

• Increasing age

• Recent urinary instrumentation or prostate procedures

• Urinary retention

• Ejaculation may temporarily increase PSA in some men

Some medications used to treat BPH, particularly finasteride and dutasteride, can substantially lower PSA and must be considered when interpreting the result.

Who Should Be Offered Screening?
 

PSA screening should involve shared decision-making. Screening has the potential to detect aggressive cancers early but can also identify slow-growing cancers that would never have caused harm. Recommendations vary somewhat among professional organizations.  For most average-risk men, discussion about PSA screening generally begins around age 50. Discussion may begin earlier, around age 40–45, for men at increased risk, including Black men, men with a strong family history of prostate cancer, and men with certain inherited genetic mutations, particularly BRCA2.
 

When Should Screening Stop?
 

There is no single stopping age appropriate for everyone.

Screening generally becomes less beneficial when a person has a limited life expectancy, because prostate cancer often develops slowly. The USPSTF recommends against routine PSA-based screening in men age 70 and older. Other organizations place greater emphasis on overall health and estimated life expectancy rather than using age alone.

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What Happens if PSA Is Elevated?
 

A newly elevated PSA is often repeated before proceeding to additional testing, because PSA levels can fluctuate. If it remains elevated or concerning, additional evaluation may include:
 

• Repeat PSA

• Percent-free PSA

• Other blood or urine prostate cancer biomarkers

• Risk calculators

• Urology referral

• Multiparametric prostate MRI

• Biopsy

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Digital Rectal Examination (DRE)
 

During a digital rectal examination, a clinician feels the back portion of the prostate through the rectum for abnormalities such as:

• Nodules

• Hard areas

• Asymmetry

• Irregularity

DRE is not a substitute for PSA testing and is not generally recommended as the primary screening test for prostate cancer. However, it may provide useful additional information in selected patients, particularly when evaluating prostate symptoms or an abnormal PSA.