The Risk Of Prostate Cancer And The Importance Of Early Screening: What Men Need To Know

Introduction

Directive Publications Cameron Y.S.Lee, DMD, MD, PHD, MPH, MSEd radiation (Rawla, 2019). The data disparity is not entirely understood, but may be due to access to health care, life expectancy, modifiable risk factors, frequency of prostate- specific antigen testing and genetic predisposition (Taitt, 2018; Bray et al, 2024). PROSTATE CANCER SCREENING Baseline prostate cancer screening may begin at age 40 to 45 years of age for men considered at increased risk, such as Black men, racial and ethical disparities, and a family history of prostate cancer (Siegel, Kratzer, Wagle, et al, 2026). The purpose of screening is to diagnose prostate cancer in asymptomatic men. Two tests that are used in screening for prostate cancer are the digital rectal examination and the prostate specific antigen (PSA) test (Basourakos, Gulati, Vince, et al, 2022). The digital rectal examination for prostate cancer screening is not recommended as a standalone screening test due to diagnostic inaccuracy (Naji, et al, 2018). It is used with the PSA test to determine the risk of clinically significant prostate cancer. The recommended screening test is measuring the serum concentration of prostate specific antigen (PSA). As PSA levels increase with advancing age due to increasing prostate gland volume, age-specific reference ranges have been established. Although PSA testing was developed greater than 25 years ago, it remains controversial in detecting prostate cancer (Vickers et al, 2023). Elevated PSA levels may occur due to benign prostatic hyperplasia, prostatitis, digital rectal examination, and use of certain medications (Nadler, et al, 1995; Schatteman, et al, 2000). This may lead to further diagnostic testing. Although the diagnostic accuracy rate is approximately 55% (Ahmed, et al, 2017), it is the author’s opinion that the benefits of PSA screening are underestimated. In the European Randomized Trial of Screening for Prostate Cancer (ERSPC), the authors demonstrated a 13% decrease in death from prostate cancer over a 30-year follow-up period in a cohort over 150, 000 men (de Koning, 2002). In a study by Schroder and colleagues, PSA screening reduced the rate of death by 20% in a cohort of 162, 243 men between the ages of 55 to 69 years over a median follow-up of 9 years (Schroder et al, 2009). In 2018, the United States Preventive Services Task Force recommended shared decision making between patients and their physician regarding PSA testing for men 55-69 years old (Grossman, et al, 2018). However, allowing patients to make their own decision to complete PSA screening may reduce the benefit of early screening for prostate cancer and survival rates. For patients diagnosed with cancer localized to the prostate gland that has not undergone distant metastasis, the 5-year survival rate approaches 100% (Raychaudhuri, Lin, Montgomery, 2025). Screening for prostate cancer is low in men age 50 and younger. Men considered considerable risk for prostate cancer should begin PSA screening between age 40- 45. (Wickes 2026). Men considered standard risk should begin PSA testing between 45-50 years old. For men 50 to 69 years old, the American Urologic Association recommends testing every 2 to 4 years. For men older than 70 years, routine PSA testing is not recommended. For high-risk populations such as Black men, The Prostate Cancer Foundation recommends early PSA testing for men ages 40 to 45 years (Garraway et al, 2024). CONCLUSION Prostate cancer is the most common type of cancer in men. After lung cancer, prostate cancer is the leading cause of death due to cancer. Therefore, screening for prostate cancer is important and includes a digital rectal examination and the prostate specific antigen (PSA) test. Early detection of prostate cancer has an extremely high 5-year survival rate approaching 100%.

References

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