The prostate is a small, walnut-sized gland situated deep within the male pelvis, just below the bladder and in front of the rectum. Its primary biological function is to produce the fluid that nourishes and transports sperm, which makes up a significant portion of semen. Because of its location, prostate cancer detection relies entirely on professional medical screening and the recognition of subtle changes in bodily function. Unlike screening for breast or testicular cancer, there is no effective or recommended physical self-exam for the prostate. Early detection depends on a person’s awareness of specific physical symptoms and a proactive discussion with a doctor about professional screening tests.
Symptoms and Self-Monitoring
Since a physical self-check of the prostate is not possible, self-monitoring focuses on recognizing changes in urinary and sexual health that could signal a problem. The prostate gland wraps around the urethra, the tube that carries urine and semen out of the body, which means that any enlargement or tumor growth can affect normal flow. Therefore, a person should be vigilant about any new or worsening urinary symptoms.
These symptoms can include a frequent or sudden need to urinate, especially during the night, or difficulty starting the stream. Other signs to look out for are a weak or interrupted flow of urine, or the feeling that the bladder has not completely emptied after urination. Sexual changes, such as pain during ejaculation or blood found in the semen or urine, should also prompt a conversation with a physician.
These changes, like frequent nighttime urination or a weaker stream, are commonly associated with benign prostatic hyperplasia (BPH), which is a non-cancerous enlargement of the prostate. However, because the symptoms of BPH and prostate cancer can overlap, any new or persistent symptom must be reported to a doctor for a professional evaluation. This distinction underscores why self-monitoring is about recognizing symptoms and not about self-diagnosis.
Professional Screening Tools
Two main methods are used by medical professionals to screen for prostate cancer: a blood test and a physical examination. The blood test measures the level of prostate-specific antigen (PSA), while the physical check is known as a Digital Rectal Exam (DRE). Both tools offer different types of information to help a doctor determine if further investigation is necessary.
The Prostate-Specific Antigen (PSA) test is a simple blood draw that measures the amount of this protein circulating in the bloodstream. PSA is naturally produced by the prostate gland, but elevated levels can be an indicator of prostate cancer. However, an elevated PSA level is not a definitive cancer diagnosis, as the protein can also be high due to non-cancerous conditions like infection, inflammation, or BPH.
The Digital Rectal Exam (DRE) involves a doctor inserting a gloved, lubricated finger into the rectum to manually feel the surface of the prostate gland. This allows the physician to check for any abnormalities in size, shape, texture, or the presence of hard nodules that could suggest a tumor. The DRE is a quick procedure that allows the doctor to assess the area of the prostate where about 80% of cancers develop. While the PSA test is considered the more effective screening tool, the DRE can sometimes detect cancers that do not produce high levels of PSA.
Determining Your Screening Schedule
The frequency of prostate cancer screening depends heavily on specific risk factors and the results of initial tests. There is no single, fixed schedule; instead, screening is a shared decision between a person and their healthcare provider, guided by established professional recommendations. The recommended starting age for screening varies based on a person’s risk profile.
For men considered to be at average risk—meaning they have no family history of prostate cancer and are not African American—the conversation about screening typically begins around age 50. The decision to start screening at this age is based on the balance between the potential benefit of early detection and the risk of over-diagnosis or side effects from subsequent treatment. The American Cancer Society suggests discussing screening at this age, while other guidelines may recommend starting at age 45.
Individuals considered to be at high risk are advised to begin the screening discussion earlier, around age 45. This group includes African American men, who face a higher risk and are more likely to develop aggressive forms of the disease. It also includes men who have a single first-degree relative (a father or brother) who was diagnosed with prostate cancer before the age of 65. For men with multiple first-degree relatives diagnosed before age 65, or those with known genetic mutations like BRCA2, screening may start as early as age 40.
Once screening begins, the frequency of future tests is often determined by the initial PSA blood test result. For people whose initial PSA level is very low (typically less than 1.0 nanogram per milliliter [ng/mL]), screening may be safely repeated every two to four years. If the baseline PSA is slightly elevated (between 1.0 ng/mL and 3.0 ng/mL), the doctor will likely recommend annual or biennial screening to monitor the level more closely. If the PSA level is greater than 3.0 ng/mL, or the DRE is suspicious, further testing, such as a biopsy, is typically warranted. Ultimately, these guidelines serve as a framework, and the final decision to continue screening, especially after age 70, should prioritize a person’s overall health and life expectancy.