Use this simple guide to navigate through conflicting information on prostate cancer and get answers.
In honor of National Prostate Cancer Awareness Month, the African American Wellness Project is teaming up with Linkwell Health, the premier digital content marketing and consumer experience technology company in healthcare, to help spread the word about prostate cancer risks, treatment, and prevention in the African American community.
If you’re a middle-aged male and wondering if it’s time to be screened for prostate cancer, the answer is … maybe? Guidelines on when and how often men should be tested have changed several times over the past decade. Trying to make sense of it all can make you want to just forget about getting screened altogether. But don’t!
Instead, use this easy-to-read guide to take charge of your prostate health. It has the answers you need to make the best screening decisions for you based on your age, race, and other key risk factors — in partnership with your doctor, of course.
Who should think about a prostate cancer screening?
If you have a prostate, you could develop prostate cancer, so screening for the disease should be on your radar. But certain risk factors raise your chances of getting the disease. Being African American is one of them.
Compared with men of other races in the U.S., Black men are 60% to 80% more likely to be diagnosed with prostate cancer, according to the American Cancer Society. Likewise, their chance of dying from the disease is twice as high. Experts are uncovering a lot of reasons for this racial divide, including genetics, lack of access to health care and affordable healthy foods, and higher rates of obesity (another risk factor for prostate cancer).
Age is another key factor. In general, older men are at higher risk for prostate cancer, especially starting at age 50. About 60% of men diagnosed with prostate cancer are 65 or older. That said, Black men are more likely to develop prostate cancer at an earlier age.
One more key risk factor for prostate cancer: family history. If you have a first-degree relative who has had prostate cancer — such as a father, son, or brother — your risk is higher. Being diagnosed under age 55 is also a sign that genetics are at play.
It’s important to remember that having risk factors for prostate cancer is not a guarantee that you will get prostate cancer. But it is your cue to talk to your doctor about taking steps to protect yourself, including getting screened when the time is right. The good news is that early detection at any age can greatly improve the chances of successful treatment.
What are the current screening guidelines?
National screening guidelines really do vary from person to person. And they’re based on when to start the conversation about screening with your doctor — not when to start actually screening. If you’re at high risk for developing prostate cancer, ask about screening at age 45. This includes African American men, who should begin screenings called prostate-specific antigen (PSA) tests at age 45, according to University of Washington Medicine. PSA is a type of protein; high levels in your blood may be a sign you have prostate cancer. Getting a baseline PSA is important, says Glen McWilliams, M.D. He’s part of the National Medical Association and a urologist in the Bronx, New York. You and your doctor can use it to monitor changes in future screenings.
If you have more than one first-degree relative who was diagnosed before they turned 65, bring screening up with your doctor even earlier — at age 40. Average-risk men can wait to start asking about it until age 50.
Once you’ve had a prostate screening, when should you return for another? Again, it depends on your personal risk level as well as your initial test results. The most important thing to do before getting a PSA test is to have a discussion with your doctor. Review your risk factors and the pros and cons of screening. Together you can make a decision that works best for your health.
How do I read my PSA results?
PSA test results are tough to interpret. What’s considered a healthy PSA level for one person may mean cancer for another. Because “normal” results are a moving target, it’s easy to get confused.
“PSA levels vary by age,” says Dr. McWilliams. If you’re between ages 50 to 60, the PSA is generally supposed to be 0-2.5, he says. For a man between 60 and 70, having a PSA of 4 is normal. Whereas a man between 70 and 80 can have an average PSA of 6.5-7.
The best way to determine what’s normal for you is by having your doctor look at how your PSA changes over time. “Getting that baseline PSA and seeing what happens the following year is much more significant than having a single test,” says Dr. McWilliams.
Your PSA level can also be higher or lower than usual because of other factors. These include:
- Prostate gland size
- Ejaculation within 2 days of screening
- Intense exercise within 2 days of screening
- Certain drugs like Propecia® (finasteride) and Avodart® (dutasteride)
- Recent prostate biopsy
Talk to your doctor — they can help you translate your results.
What do I need to know about false positives?
Cancer screenings in general have important benefits. They can catch cancer early and set the stage for receiving lifesaving treatment. But prostate cancer tests are a little trickier.
Some experts worry that screening too early can lead to false positives, which occur nearly 25% of the time, according to the National Cancer Institute. A false positive can lead to unnecessary treatments like radiation therapy or surgery that can be more dangerous than prostate cancer itself, especially in older people.
But if you fall into the high-risk category, the benefits of screening can outweigh the risks of a false positive. Speak with your doctor to develop a personalized screening plan.
“If the PSA is elevated, we want to confirm it with another test at least six weeks later,” says Dr. McWilliams. Some people may be prescribed antibiotics for two weeks if the provider suspects an infection is causing the elevation. “We don’t necessarily run a biopsy without ruling out other causes.”
Bottom line: Early detection of prostate cancer is key. The earlier it’s caught, the more successful the treatment. So talk to your doctor about the best time for you to jump into screening.
American Cancer Society (2019). “Cancer Facts and Figures for African Americans 2019 – 2021″
International Journal of Environmental Research and Public Health (2019). “Associations between Obesity, Obesogenic Environments, and Structural Racism Vary by County-Level Racial Composition.”
American Society of Clinical Oncology Educational Book (2019). “All men are created equal: Addressing disparities in prostate cancer care”
American Society of Clinical Oncology (2021). “Prostate Cancer: Risk Factors and Prevention.”
American Cancer Society (2021). “American Cancer Society Recommendations for Prostate Cancer Early Detection.”
University of Washington Medicine (2021). “Black men should start prostate-cancer screening at age 45”
National Cancer Institute (2022). “Prostate-specific antigen (PSA) test”
Prostate Cancer Foundation (n.d.) “The prostate-specific antigen test”