The Simple Blood Test Most Men Aren't Asking About (But Should Be)
Prostate cancer is the most common cancer in American men, other than skin cancer.
About 1 in 8 men will be diagnosed in their lifetime. Yet many men never have a conversation with their doctor about screening, often because they don't know it's a decision they get to make.
Prostate cancer screening starts with a simple blood test called the PSA test. Here's what every man should know about it.
What Is a PSA Test?
PSA stands for prostate-specific antigen, a protein made by the prostate gland. A small amount normally shows up in the blood. Higher levels can be a sign of prostate cancer, but they can also be caused by other things, including:
An enlarged prostate (BPH), which is very common as men age
Inflammation or infection of the prostate
Recent ejaculation or vigorous cycling
Some medical procedures involving the prostate
That's why a high PSA isn't a diagnosis. It's a signal to look closer.
Why PSA Screening Is a Shared Decision
You may have heard that PSA screening is "controversial." Here's why.
The benefit: PSA screening can find prostate cancer early, when it's most curable, and it lowers the risk of dying from prostate cancer.
The concern: Many prostate cancers grow so slowly they would never cause harm. In the past, screening led many men to be treated for cancers that didn't need treatment, sometimes with side effects like urinary leakage or erectile dysfunction.
The good news is that care has changed. Today, many men with low-risk prostate cancer are managed with active surveillance, which means close monitoring instead of immediate surgery or radiation.
That shift has made screening safer and smarter. The goal is to find the cancers that matter and leave alone the ones that don't.
When Should You Start?
Guidelines differ slightly, but here's a practical summary:
Average-risk men: Talk with your doctor about screening starting at age 50 (American Cancer Society). The U.S. Preventive Services Task Force recommends an individual decision for men 55 to 69.
Higher-risk men: Start the conversation at age 45. This includes Black men and men with a father or brother diagnosed with prostate cancer before age 65.
Highest-risk men: Start at age 40 if you have more than one close relative diagnosed at an early age, or a known inherited mutation such as BRCA2.
The American Urological Association recommends that men consider a baseline PSA between 45 and 50, and as early as 40 to 45 for men at higher risk. That first number helps your doctor track changes over time.
Prostate Cancer and Black Men
This is personal for me. Black men are about 70% more likely to be diagnosed with prostate cancer and about twice as likely to die from it compared with White men.
They're also more likely to be diagnosed at a younger age and with more advanced disease. [read more in our Disparities series]
Many of the major studies that shaped the screening guidelines included very few Black men. That's one reason experts now recommend Black men start the screening conversation earlier. If you're a Black man in your 40s, don't wait for your doctor to bring it up. Ask.
What Happens If Your PSA Is High?
A high PSA usually leads to a step-by-step approach, not an immediate biopsy:
Repeat the test to confirm the result.
Get a prostate MRI, which helps show whether there's an area that looks suspicious.
Consider additional blood or urine tests that help estimate the chance of an aggressive cancer.
Biopsy, if the results point to a meaningful concern.
This modern approach helps many men avoid unnecessary biopsies.
Don't Ignore Symptoms
Early prostate cancer usually causes no symptoms, which is why screening matters. But see a doctor if you notice:
Trouble urinating or a weak stream
Frequent urination, especially at night
Blood in your urine or semen
Pain in your back, hips, or pelvis that won't go away
These symptoms are often caused by noncancerous conditions, but they should always be checked.
Frequently Asked Questions
What is a normal PSA level?There isn't one number that fits everyone. PSA naturally rises with age and prostate size. Your doctor will look at your result in context, including your age, prior results, and how quickly your PSA is changing.
Do I need a rectal exam?Not necessarily. The digital rectal exam is now considered optional for routine screening. The PSA blood test is the main screening tool.
How often should I get a PSA test?Usually every 1 to 2 years for most men who choose screening, though men with very low PSA levels may be tested less often. Your doctor will tailor the interval to your results.
Does insurance cover PSA testing?Medicare covers an annual PSA test for men 50 and older. Most private insurers cover PSA screening, but check your plan, especially if you're starting before 50.
When can I stop screening?Most men don't benefit from routine screening after age 70. Talk with your doctor about your overall health.
Take the Next Step with EDDIE Prostate
Wondering whether to get screened, or what your PSA result means? EDDIE Prostate, your AI-powered prostate cancer copilot, can walk you through it in plain language, 24/7. Download it free on the App Store today.
This article is for educational purposes only and is not a substitute for professional medical advice. Talk with your healthcare provider about whether prostate cancer screening is right for you.
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