Can Prostate Cancer Be Found Early?

Prostate cancer can often be found early with a blood test to check your prostate-specific antigen (PSA) level. The PSA test can be done as a screening test to find cancer in people before they have symptoms.

Screening for prostate cancer with the PSA blood test

Prostate cancer can often be found early by testing for the prostate-specific antigen (PSA) level in a man’s blood.

If the result of a screening PSA blood test is abnormal (high), further testing will likely be needed. Your doctor might recommend repeating the PSA test or getting other tests, such as a prostate MRI or biomarker test. If these tests suggest you might have prostate cancer, your doctor might recommend a prostate biopsy to find out.

Pros and cons of prostate cancer screening

Prostate cancer screening has benefits, but it is not perfect. It has possible risks and limitations as well.

Screening can find prostate cancer early

The main benefit of screening is that if prostate cancer is found, it’s likely to be at an earlier stage than if it were found after it started causing symptoms. This will most likely mean that the cancer is easier to treat. If the cancer hasn’t spread outside the prostate, it can most likely be cured with treatment, which might save your life.

The PSA test is not perfect

The PSA blood test result can sometimes be high even when a man does not have cancer. This is known as a false-positive result.

A false-positive result can cause unnecessary anxiety. And it might lead some men to get a prostate biopsy, even when they don’t have cancer. Prostate biopsies are usually safe, but they do carry a small risk of pain, infection, and bleeding.

False-positive tests that result in unnecessary biopsies are less of a problem now than they were in the past. Instead of going straight to a prostate biopsy after a positive PSA result, doctors now have options for determining whether a biopsy is needed.

Repeating the PSA test, typically after at least a couple of weeks, is now recommended as the first step if a PSA level is high, to help make sure the result is accurate.

Newer tests, such as improved versions of prostate MRI and lab tests that look for specific biomarkers in blood or urine samples, can help doctors determine the next best step.

Although it’s less common, the PSA test result might be normal even when someone does have prostate cancer. This is known as a false-negative result.

Not all prostate cancers need to be treated right away

Not all prostate cancers are the same. Some might grow quickly, but some grow slowly and likely would never cause serious health issues during a man’s life, even if they’re not treated.

Because of screening, some men may be diagnosed with a prostate cancer that they never would have known about otherwise. It would never have led to their death or even caused any symptoms. Finding a disease like this that would never cause problems is known as overdiagnosis.

Some of these men might still be treated with surgery or radiation. This might be because the doctor can’t be sure how quickly the cancer might grow and spread, or because the man is uncomfortable knowing he has cancer that isn’t being treated. Treatment of a cancer that would never have caused any problems is known as overtreatment. Even if a treatment like surgery or radiation wasn’t needed, it can still cause urinary, bowel, and/or sexual side effects that can affect quality of life.

Fortunately, overdiagnosis and overtreatment are less common than they were in the past. Using newer tests and updated information, doctors are now better able to determine which cancers need to be treated right away and which ones can be managed by being watched closely instead, an approach called active surveillance. But men choosing this approach still need regular PSA tests, prostate biopsies, and possibly imaging tests such as MRI to monitor their cancer to determine if treatment has become necessary. These tests can lead to their own issues, including anxiety, as well as risks of pain, infection, and bleeding from biopsies.

Men should know the benefits, limits, and possible harms of screening

Several large studies have shown that screening can help lower the risk of dying from prostate cancer, but exactly how much screening might lower this risk isn’t clear.

The American Cancer Society recommends that men be screened for prostate cancer with the PSA blood test, starting at age 50 if they are at average risk, or at age 45 if they are at higher risk. To learn more, see American Cancer Society Guideline for Prostate Cancer Early Detection.

Before you start screening, your healthcare provider should make sure you are informed about:

• The potential benefits, limits, and possible harms of screening
• The follow-up tests you might need if your PSA level is high
• Active surveillance being offered as the initial approach if you are found to have prostate cancer that has a low risk of growing or spreading