How to Check for Prostate Cancer?

Prostate cancer is one of the most common types of cancer affecting men, especially those over 50. Despite its prevalence, many men remain unaware of the early signs or how to get tested. Unlike other diseases with obvious symptoms, prostate cancer often grows silently, which makes timely detection essential.

Understanding how to check for prostate cancer can save lives. The earlier it’s caught, the higher the chances of successful treatment. This guide aims to equip you with essential information — including what screening tests are available, when to take them, who is most at risk, and how results are interpreted.

Whether you’re concerned about your own health or looking out for someone you love, learning how to check for prostate cancer is a proactive step toward long-term well-being. From simple blood tests to advanced imaging and biopsy procedures, we’ll explain every step clearly, helping you make informed choices.

1. What Is Prostate Cancer?

The prostate is a small gland in men, roughly the size of a walnut, located below the bladder and in front of the rectum. Its primary role is to produce seminal fluid that nourishes and transports sperm.

Prostate cancer develops when abnormal cells in the prostate begin to grow uncontrollably. While many prostate cancers grow slowly and may not cause harm during a man’s lifetime, some types are aggressive and can spread quickly to other organs if not treated in time.

There are different types of prostate cancer, but the vast majority are adenocarcinomas. These begin in the gland cells and are generally slow-growing. However, other less common types like small cell carcinomas, neuroendocrine tumours, or sarcomas can be more aggressive.

Globally, prostate cancer is the second most commonly diagnosed cancer among men, after lung cancer. According to recent data, approximately 1 in 8 men will be diagnosed with prostate cancer during their lifetime. While the risk increases with age, especially after 50, it can also affect younger men in high-risk categories.

One of the biggest challenges in treating prostate cancer is its stealthy nature. In early stages, it usually causes no symptoms. This makes regular screening essential, especially for men in higher risk groups.

2. Who Should Consider Screening?

Knowing when and whether to get screened for prostate cancer is crucial. Not all men need immediate testing, but for some, early screening can make all the difference.

2.1 Age-Based Guidelines

Most health authorities, including the American Urological Association (AUA), recommend starting prostate cancer screening at age 50 for men at average risk. However, for men with certain risk factors, screening should start earlier:

At age 45 for those with a family history of prostate cancer (especially in a father, brother, or son).
At age 40 for those with multiple first-degree relatives affected or those of African ancestry, who are more prone to aggressive prostate cancers.

2.2 Family History & Genetic Risk

If prostate cancer runs in your family, especially among close male relatives, your risk nearly doubles. Also, mutations in genes like BRCA1 or BRCA2, often associated with breast cancer, also increase prostate cancer risk in men. If you’re aware of these mutations in your family, consult a doctor about early screening.

2.3 Lifestyle & Ethnicity

Certain ethnicities, like African or Caribbean men, have higher incidences and more aggressive forms of prostate cancer. Additionally, poor lifestyle habits such as smoking, a high-fat diet, or obesity may raise risks.

2.4 When Screening May Not Be Needed

Screening might not be beneficial for men over 70 years old or those with serious underlying health conditions and limited life expectancy. That’s because many prostate cancers are slow-growing and may not affect quality of life in older age.

2.5 Informed Decision-Making

Since prostate cancer screening is a personal decision, it’s important to talk to your doctor about your risks, concerns, and expectations. They can help you weigh the benefits and risks based on your individual health profile.

3. Primary Screening Tests

3.1 PSA (Prostate-Specific Antigen) Blood Test

The PSA test is the most common screening tool for prostate cancer. It measures the level of PSA, a protein produced by both normal and cancerous prostate cells, in the blood.

What Are Normal PSA Levels?

Under 2.5 ng/mL: Typically considered normal.
2.5–4.0 ng/mL: Considered borderline, further tests may be required.
Above 4.0 ng/mL: May indicate prostate cancer but not always inflammation, infection, or enlargement can also raise PSA.

Factors That Influence PSA

Age: PSA naturally increases with age.
Ejaculation: Can temporarily increase PSA.
Cycling or prostate manipulation (like during a DRE): May elevate PSA.
Prostatitis or benign prostatic hyperplasia (BPH): Can mimic cancer by raising PSA.

Advanced PSA Measurements

PSA Velocity: How fast PSA levels change over time.
PSA Density: Compares PSA level to prostate size.
Free vs. Bound PSA: Lower free PSA percentage may indicate cancer.

3.2 Digital Rectal Exam (DRE)

A DRE involves a doctor gently inserting a gloved, lubricated finger into the rectum to feel the back of the prostate.

What the Doctor Looks For:

Hard lumps.
Irregular shape or texture.
Unusual enlargement.

DRE is quick, low-cost, and adds useful information when combined with PSA. However, it may not detect very early cancers located deeper in the gland.

3.3 PSA + DRE Combo

Most screening guidelines recommend using both tests together. While PSA is more sensitive, DRE can sometimes detect abnormalities missed by the blood test. Together, they offer a more accurate picture.

4. Additional & Emerging Tests

While PSA and DRE remain the cornerstones of prostate cancer screening, advancements in medical technology have introduced new tools that offer more accurate and less invasive diagnostic options.

4.1 Free-to-Total PSA Ratio

When a PSA result is borderline (e.g., between 4–10 ng/mL), doctors may recommend checking the free-to-total PSA ratio. PSA circulates in two forms:

Free PSA: Unbound in the bloodstream.
Total PSA: Combined free and bound PSA.

A low free PSA percentage (usually less than 10%) increases the likelihood of prostate cancer. A higher percentage suggests a benign cause like BPH.

4.2 Prostate Health Index (PHI)

PHI combines three markers:

Total PSA
Free PSA
[-2]proPSA (an isoform of PSA linked to cancer)

This index is more accurate than PSA alone in distinguishing between prostate cancer and benign conditions, especially when PSA levels are in the “grey zone” (4–10 ng/mL).

4.3 PCA3 Urine Test

The PCA3 test looks for a prostate cancer gene (PCA3) in your urine after a DRE. It’s non-invasive and useful for:

Deciding whether a repeat biopsy is necessary.
Avoiding unnecessary procedures.

PCA3 is not used for initial screening, but rather to help refine diagnosis after ambiguous PSA results.

4.4 4Kscore Test

This blood test assesses:

Total PSA
Free PSA
Intact PSA
Human kallikrein 2 (hK2)

Combined with age, DRE findings, and prior biopsies, it calculates the likelihood of aggressive cancer. It’s designed to reduce unnecessary biopsies.

4.5 Multiparametric MRI (mpMRI)

mpMRI has revolutionised how doctors detect prostate cancer. It uses multiple imaging sequences to identify suspicious areas within the prostate.

Advantages:

Non-invasive.
Helps target biopsies to abnormal areas.
Reduces the need for random biopsies.

In some cases, an MRI-only diagnosis is possible when a biopsy isn’t feasible or is inconclusive.

4.6 Genetic & Genomic Tests

Some advanced diagnostic platforms analyse the genes in prostate tissue to assess how aggressive the cancer may be. These include:

Oncotype DX
Prolaris
Decipher

While not yet used in screening, these tools help in treatment decisions once cancer is confirmed.

5. Confirming Diagnosis: Biopsy & Imaging

Once initial tests suggest prostate cancer, a biopsy is required to confirm the diagnosis.

5.1 When Is a Biopsy Recommended?

A doctor may suggest a biopsy if:

PSA is above 4 ng/mL (especially if rising rapidly).
DRE detects abnormalities.
MRI shows suspicious lesions.
You’ve had a previous negative biopsy but rising PSA persists.

5.2 Types of Prostate Biopsy

The most common types are:

Transrectal Ultrasound (TRUS)-Guided Biopsy

A probe is inserted into the rectum.
A needle extracts 12+ tissue samples.
Local anaesthetic is used.

Transperineal Biopsy

Needle is inserted through the skin between scrotum and anus.
Lower infection risk than TRUS.

MRI-Fusion Biopsy

Combines MRI and ultrasound imaging.
Targets suspicious areas more precisely.

5.3 Risks of Biopsy

Bleeding (rectal or in urine/semen)
Discomfort
Infection (~1% chance, managed with antibiotics)

5.4 Interpreting Biopsy Results – Gleason Score

Once tissue is collected, a pathologist checks for cancer cells. They assign a Gleason score, ranging from 6 to 10:

Gleason 6: Low-grade, slow-growing cancer.
Gleason 7: Intermediate-grade.
Gleason 8–10: High-grade, aggressive cancer.

5.5 Staging the Cancer

Doctors use the TNM system to stage the cancer:

T (Tumour): Size and location in prostate.
N (Nodes): Has it spread to lymph nodes?
M (Metastasis): Has it spread to bones or other organs?

Bone scans, CT scans, and PET-MRI may also be ordered if cancer appears aggressive.

6. Risk Assessment & Shared Decision Making

Prostate cancer screening isn’t one-size-fits-all. Every man has unique risk factors, and screening can come with both benefits and drawbacks. That’s why shared decision-making between a patient and doctor is key to choosing the right approach.

6.1 Why Risk Assessment Is Crucial

Not every elevated PSA level points to cancer. Likewise, not all cancers are aggressive or require treatment. A good risk assessment involves:

Your age
Family history
Race or ethnicity
Genetic factors (like BRCA mutations)
PSA trends
Other health conditions

If your life expectancy is less than 10 years, screening may not be helpful since many prostate cancers grow slowly and won’t affect life quality or duration.

6.2 Shared Decision-Making Explained

Shared decision-making means you and your doctor make health decisions together, considering:

Your personal risk and medical background.
The possible outcomes of screening.
Your values and preferences (e.g., some men prefer early detection even with false alarms, others want to avoid unnecessary procedures).

6.3 When It’s Most Important

Shared decision-making is especially vital when:

PSA is borderline (4–10 ng/mL).
You have anxiety about prostate cancer.
You’re unsure whether to proceed with a biopsy.
Imaging results are unclear, and further action could go either way.

6.4 Questions to Ask Your Doctor

What are my chances of having prostate cancer?
What are the risks of the tests?
What happens if I don’t do anything right now?
If cancer is found, what treatment options are available?

Having this conversation helps you make a confident, informed choice that fits your lifestyle, health status, and peace of mind.

7. What the Tests Mean

Understanding the results of your PSA, DRE, or biopsy tests is key to knowing your next steps. Here’s what you need to know.

7.1 PSA Test Results

Low PSA (<2.5 ng/mL): Usually reassuring. Repeat every 2–4 years.
Borderline PSA (2.5–4 ng/mL): Monitor and consider advanced tests.
High PSA (>4 ng/mL): May lead to further investigation like MRI or biopsy.

Note: A single high PSA doesn’t confirm cancer. Doctors look at trends over time, called PSA velocity.

7.2 DRE Findings

Normal DRE: Smooth, symmetrical prostate.
Abnormal DRE: Hard lumps, nodules, or asymmetry. May suggest cancer, especially if PSA is also elevated.

DRE is less precise but valuable when used with PSA testing.

7.3 Biopsy Results

If a biopsy is done, the Gleason score helps determine how aggressive the cancer is:

6 or below: Low risk. Often managed with active surveillance.
7: Intermediate. May need treatment depending on staging.
8–10: High risk. Usually requires immediate treatment.

7.4 When Results Are Inconclusive

Sometimes results don’t clearly point to cancer or benign issues. In such cases:

You might repeat PSA after a few months.
Consider MRI to guide further biopsies.
Genomic tests may help assess cancer aggressiveness.

7.5 What If You Have Cancer?

If prostate cancer is diagnosed:

Early-stage cancer may just be monitored (active surveillance).
More aggressive cancer may need surgery, radiation, or hormone therapy.
Your doctor will customise a plan based on risk level, age, and overall health.

8. Lifestyle & Prevention

Although prostate cancer can’t always be prevented, adopting a healthier lifestyle may reduce the risk or help slow progression in men already diagnosed.

8.1 Eat a Prostate-Friendly Diet

Research suggests that diets rich in certain nutrients can support prostate health and potentially lower cancer risk.

Foods to Focus On:

Tomatoes (rich in lycopene)
Cruciferous vegetables (broccoli, cauliflower)
Omega-3 fatty acids (found in salmon, walnuts, flaxseeds)
Green tea

Foods to Limit:

Red meat and processed meats
Full-fat dairy products
Saturated fats and fried foods

Eating a plant-based, high-fibre diet is generally recommended for all men, particularly those over 40.

8.2 Exercise Regularly

Staying physically active helps maintain a healthy weight and hormone balance, which may reduce prostate cancer risk.

Recommendations:

150 minutes of moderate exercise per week (e.g., walking, cycling)
Strength training at least twice per week

Exercise also boosts your immune system and may help your body fight off abnormal cell growth.

8.3 Quit Smoking & Reduce Alcohol

Smoking is linked to more aggressive forms of prostate cancer. Quitting not only improves prostate health but overall life expectancy. Alcohol should be consumed in moderation (if at all), as excess intake can also affect hormone levels.

8.4 Sleep & Stress Management

Poor sleep and chronic stress can disrupt immune function. Aim for:

7–8 hours of sleep each night.
Mindfulness techniques such as meditation, yoga, or breathing exercises.

8.5 Supplements – Myths vs. Facts

Some men turn to supplements like saw palmetto, selenium, or vitamin E. However, studies show no strong evidence that they prevent prostate cancer. Always speak with your doctor before starting any supplement.

FAQs:

Q1: Can prostate cancer be found early?

Yes. Screening with PSA and DRE can detect prostate cancer before symptoms appear. Early detection increases treatment success.

Q2: How often should men be screened?

Every 2 years if PSA is normal and risk is average.
Every year if PSA is borderline or high-risk profile.

Your doctor may adjust this based on age and history.

Q3: Is the screening process painful?

PSA blood test: No pain, just a standard blood draw.
DRE: May feel slightly uncomfortable but lasts only a few seconds.

Biopsies may cause discomfort but are performed with local anaesthesia.

Q4: What if I have no symptoms?

That’s common. Prostate cancer often causes no early symptoms, which is why regular screening is essential especially after 50.

Q5: Are at-home PSA kits accurate?

At-home PSA kits exist, but they are less reliable due to improper handling and lack of medical oversight. Always consult a professional for accurate results.

Q6: Is an elevated PSA always cancer?

No. Conditions like BPH, prostatitis, or even recent sexual activity can elevate PSA. Doctors use additional tests to confirm the cause.

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Final Summary:

Prostate cancer is a serious health concern but with early detection, it can be managed or even cured. The key lies in understanding how to check for prostate cancer effectively, based on your personal risk profile.

Start by knowing your numbers. PSA blood tests, when combined with DRE and supported by advanced tools like MRI or genomic testing, offer a complete picture. If your levels are normal, that’s great — keep monitoring. If something seems off, don’t panic. Many factors influence PSA, and not all elevations mean cancer.

Discuss your family history, age, and lifestyle with your doctor. Together, you can create a screening plan that’s tailored for you. Prostate cancer caught early is very treatable, often without aggressive therapy.

Beyond tests, look after your body. A nutrient-rich diet, exercise, stress control, and quitting smoking will benefit not only your prostate but your overall well-being.

If you’re 50 or older (or younger with risk factors), take control of your health today. Ask your doctor about checking for prostate cancer. A simple test might save your life.