Who should consider screening?
- Most men, starting the discussion at age 50
- Age 45 for Black men and those with a family history of prostate, breast, ovarian, or pancreatic cancer
- Age 40 for men with known BRCA mutations or very high-risk family history
- Screening usually stops around age 70 or when life expectancy is under ~10 years
How screening works today
- Baseline PSA and digital rectal exam
- Interpret PSA in context: age, prostate size, medications (finasteride/dutasteride roughly halve PSA), inflammation
- When PSA is concerning: repeat, then risk-stratify with tools like PSA density, free PSA, 4Kscore, or PHI
- Multiparametric prostate MRI has become central — it selects who benefits from biopsy and where to target it
- MRI-fusion targeted biopsy when a PI-RADS 4–5 lesion is present
Benefits and risks
Screening reduces death from prostate cancer in the right population but can also identify low-risk cancers that never would have caused harm. Active surveillance is the standard for low-risk disease and avoids over-treatment.
Lifestyle and prostate wellness
Cardiometabolic health (weight, exercise, blood pressure, blood sugar), a Mediterranean-style diet, and limiting ultra-processed foods support long-term prostate wellness. Selected professional-grade supplements may play a supportive role — discuss with your clinician.