If you have a prostate, you probably don’t think about it much. But there are reasons why you may want to give it a bit more attention. One important reason is preventing prostate cancer.
In the United States, prostate cancer is the second most common cancer among men and those assigned male at birth. About 1 in 8 males will be diagnosed with prostate cancer during their lifetime.
Prostate cancer can be serious, but it doesn’t usually lead to death for those who have it. There are treatments that help, especially if the cancer is found in its earliest stages. That’s where regular prostate cancer screenings come in. They’re the best way to detect and catch the disease early.
At what age should you start prostate cancer screening? How often should you be screened? What happens during prostate cancer screening? We answer all those questions and more.
The prostate-specific antigen test
The most effective way to screen for signs of prostate cancer is through the prostate-specific antigen (PSA) blood test. PSA is a protein made by cells of the prostate gland. While PSA is mostly found in semen, a small amount can be found in your blood.
Prostate cancer can increase your PSA level. However, it’s important to note that there are other reasons for a higher PSA level, including aging and other health conditions. Some of these factors can cause long-term changes in PSA levels, while others cause temporary changes.
Because of this, a PSA test can’t diagnose prostate cancer (or any other condition), but it can let you and your doctor know when additional testing might be needed to rule out health problems.
What happens during a PSA test?
As with any blood test, a nurse or medical technician will collect blood from a vein in your arm and send it into a lab. With this test, they check for how many nanograms (ng) of PSA are in each milliliter (ml) of your blood.
People who should get prostate cancer screening
Recommendations for prostate cancer screening can vary based on your risk of prostate cancer, overall health, results from previous testing and preferences. But it’s your choice whether or not you’d like to be screened for cancer.
Prostate cancer screening age
Talking to your doctor is the best way to learn when you should start screening. It’s a good idea to ask your doctor about screening when you’re about 50 years old. If you have risk factors for prostate cancer, bring it up sooner.
The age range for prostate cancer screenings is usually between 55-69 years old. But your doctor may recommend you start screening sooner (possibly as early as age 40) or continue for longer.
When to talk to your doctor about prostate cancer screening
| Risk factors | Talk to your doctor at |
|---|---|
| African American | 40+ years old |
| Family history of prostate cancer | 40+ years old |
| Of average risk | 50+ years old |
People who may benefit from earlier prostate cancer screenings
- Those with African American ancestry – People who are African American are more likely to get prostate cancer, get cancer at a younger age and have more advanced disease when it’s found. Compared to other men, African Americans are twice as likely to die because of the disease.
- Those with a family history of prostate cancer – A person is more likely to get prostate cancer if they have one or more first-degree relatives (father or brother) with prostate cancer, or there’s two or more relatives in their extended family with the disease.
Getting prostate cancer screening is a choice
It’s up to you whether or not to get screened for prostate cancer. And while it’s always good to find cancer in the early stages when it’s most treatable, prostate cancer screening may not make sense for you right now.
Because prostate cancer is often such a slow-growing disease, it’s possible that even if the cancer is found, it may not affect the length or quality of your life. False positives can also be a concern. As mentioned above, it’s possible to have high PSA levels even though there’s no cancer. So for some patients, screening may lead to unclear results and an unnecessary evaluation.
Still, it’s a good idea to have a conversation with your doctor about whether to get screened. They can help you understand the benefits and risks based on your age, overall health and preferences. Your next wellness checkup would be the perfect time to talk about prostate cancer. If you’re overdue, schedule a preventive care visit today.
If you and your doctor decide to go forward with a screening test, the time between future screenings will depend on the results. Some people need to be screened annually, while others may only need screening every couple of years.
What it means when a PSA test result level is high
A PSA level that’s high doesn’t necessarily mean that you have cancer or another medical condition. Remember, PSA levels can’t diagnose any health condition since there are many reasons why PSA levels may be higher or lower than expected. Here’s what to know about PSA levels.
Normal PSA levels change with age
PSA levels between 0 and 4 ng/ml are typically considered normal, but levels naturally increase with age.
| Age | PSA level |
|---|---|
| 40 to 49 years old | 0 to 2.5 ng/ml |
| 50 to 59 years old | 3.0 to 4.0 ng/ml |
| 60 to 69 years old | 4.0 to 4.5 ng/ml |
| 70+ years old | 5.0 to 6.5 ng/ml |
The risk of cancer goes up with PSA levels
As the PSA levels in your blood go up, so does the chance of prostate cancer. Here’s how PSA levels relate to cancer risk:
- Most men without prostate cancer have PSA levels under 4 ng/ml.
- If your PSA is between 4 and 10 ng/ml, there’s a 25% chance that you have prostate cancer.
- If your PSA is over 10 ng/ml, your chance of having prostate cancer is about 50%.
But it’s important to know that a higher PSA level doesn’t necessarily mean you have cancer. And a low PSA level doesn’t necessarily mean you’re cancer free.
PSA levels can be high even if you don’t have cancer
High PSA levels are usually a sign that something’s going on in your body. We’ve explained that it could mean prostate cancer, but oftentimes something else is the cause:
- Ejaculation – When you ejaculate, it can increase your PSA level for a couple of days. That’s why your doctor may ask you to refrain from sex for 24-48 hours before the test.
- Bicycling – Some studies show that biking can temporarily increase your PSA level, possibly because of how a bike seat pushes against the prostate.
- Some medicines – Medications that increase testosterone can also increase your PSA level.
- Other prostate conditions – Your PSA level may be higher if you have a condition like benign prostatic hyperplasia (BPH), which is a noncancerous enlargement of the prostate, or if your prostate is inflamed or infected (a condition called prostatitis).
PSA levels can be low even if there’s cancer
Certain medications and a higher body weight can lead to lower PSA levels, and a doctor won’t be able to tell that a person’s PSA levels are being affected by cancer. Here are factors that can lower PSA levels:
- Medications used to treat BPH – 5-alpha reductase inhibitors such as finasteride and dutasteride can lower your PSA level.
- Herbal supplements – Some over-the-counter herbal mixtures can lower PSA.
- Other medications – It’s also possible that long-term use of aspirin, statins and diuretics can lower PSA.
- Excess body weight – Being very overweight can significantly reduce your PSA level.
What happens if your PSA level is high: Follow-up testing
Your doctor will likely recommend additional testing if your PSA level is outside normal range for your age, or has risen abruptly toward the upper limit of what’s considered normal. It’s also possible your doctor may recommend additional tests even if your level is lower – that’s because PSA levels are just one factor that doctors use when determining next steps for someone with elevated PSA levels.
Other factors include your age, the size of your prostate and PSA levels over time. For example, if your levels were stable for a couple of years and then go up significantly, your doctor may suggest additional testing. But it’s important to know that there’s no one-size-fits-all process here. If cancer is a concern, you’ll work with your doctor to determine what the best next steps are.
Prostate MRI
If your PSA levels are elevated, the next step is usually prostate MRI (magnetic resonance imaging). This is a noninvasive test that doctors use to look inside your body for signs of cancer. During an MRI, you’ll lie on a table inside a tube-like machine that takes detailed pictures of the prostate. Your doctor will use these pictures to determine if there are signs of cancer or other prostate problems that could be raising your PSA levels. This test takes about 30-45 minutes.
Prostate biopsy
A prostate biopsy can also be used to determine what’s causing elevated PSA levels. During a biopsy, tissue samples are taken from your prostate gland so they can be tested by a lab to see if there are any cancerous cells. The entire procedure takes about 10 minutes, and you’ll receive a local anesthetic to reduce discomfort.
If you’re unable to get a prostate MRI, a prostate biopsy may be used right away. You may also need a biopsy after a prostate MRI depending on your results. In this case, the doctor who performs the biopsy will use the MRI images to sample tissue from areas that look concerning.
Cost of prostate cancer screening varies
The cost of a PSA blood test is usually between $100 and $300 without insurance. If you have insurance, PSA tests are usually covered but they’re not considered preventive like some other cancer screenings. This means you’ll have some out-of-pocket costs. For example, if you have coinsurance where you pay 20% of the cost, you may need to pay $40-$60 for the test.
Talk to a doctor about prostate cancer screening
Now is always the right time to take care of yourself. If you have questions or concerns about prostate cancer screenings, the perfect time to talk about them is during your next preventive care visit. So if you’re due for a visit, get it scheduled today.
Since so many things can affect your PSA level, it’s important to discuss your behaviors, medical conditions, medications and supplements with your doctor. In most cases, a PSA blood test is still an option, it’s just that your doctor will take that information into consideration when providing recommendations for next steps.
If you’re having problems with your prostate or are experiencing concerning symptoms like painful urination or difficulty emptying your bladder, schedule a primary care appointment with your doctor. They’ll be able to help determine the cause of your symptoms and the best treatment. They may also recommend that you see a urologist, a doctor who specializes in diagnosing and treating diseases of the male reproductive system.