Prostate cancer is the most common cancer in American men after skin cancer. Most prostate cancers grow slowly and never cause problems, but some are aggressive. The PSA blood test can find prostate cancer early. Whether to get tested is a personal choice, and it’s one worth making with good information.
What is the PSA test?
PSA (prostate-specific antigen) is a protein made by the prostate. A simple blood test measures it. Higher levels can be a sign of cancer, but they can also be raised by an enlarged prostate, infection, recent ejaculation or a long bike ride.
The benefits
For some men, screening finds an aggressive cancer early, when it can be cured. Large studies show PSA screening slightly lowers the chance of dying from prostate cancer and of the cancer spreading.
The downsides
- False positives: A high PSA often isn’t cancer but can lead to worry and more tests, including biopsies.
- Overdiagnosis: Screening finds many slow-growing cancers that would never have caused harm.
- Treatment side effects: Surgery or radiation can cause erection problems and urinary leakage.
Practice has improved. Many slow-growing cancers are now watched closely with active surveillance instead of treated right away, and MRI scans help decide who really needs a biopsy.
Who should consider screening
- USPSTF: Men 55 to 69 should decide with their doctor whether to be screened. Routine screening isn’t recommended at 70 and older. The task force is currently updating this guidance.
- American Cancer Society: Start the conversation at 50 for average risk, at 45 for Black men and men with a father or brother diagnosed before 65, and at 40 for men with more than one close relative diagnosed young.
Black men are about 1.7 times more likely to be diagnosed and about twice as likely to die from prostate cancer, so earlier conversations matter.
Questions to ask your doctor
- What is my personal risk, based on age, race and family history?
- If my PSA is high, what would happen next?
- Would you recommend active surveillance if a low-risk cancer is found?
- How often should I be tested?
Symptoms to report
Early prostate cancer usually causes no symptoms. See a doctor for trouble urinating, blood in urine or semen, or new bone pain. These often have other causes, such as an enlarged prostate, but should be checked.
What this means for you
- If you’re 50 or older, or 45 with higher risk, bring up PSA testing at your next visit.
- Know your family history, including breast and ovarian cancer, which can point to inherited gene changes.
- Staying active and eating well supports overall health. Try our strength training guide for over 50.
The bottom line
PSA screening isn’t right or wrong for everyone. It’s a decision to make with your doctor, weighing your risk and values. See our cancer screening guide by age for other recommended tests.
Common questions
Is the digital rectal exam still needed?
It’s no longer recommended as a routine screening test on its own, but your doctor may use it alongside PSA in some cases.
What PSA level is normal?
There’s no single cutoff. Doctors look at your level, your age and how it changes over time. Many use 4.0 ng/mL as a general threshold for further checks.
Does Medicare cover PSA tests?
Yes. Medicare covers a yearly PSA blood test for men 50 and older.
This article is for general information and isn’t medical advice. Talk with your healthcare provider about your individual needs.
