Prostate Cancer Screening

What it is

Prostate cancer screening means testing a man who has no symptoms, usually with a blood test called PSA. PSA is a substance made mostly by the prostate that may be found in increased amounts in the blood of men who have prostate cancer [2].

Why this guide is written for Black patients

The US Preventive Services Task Force, in its 2018 recommendation and using National Cancer Institute figures from that year, states that African American men are more likely to develop prostate cancer than white men, 203.5 against 121.9 cases per 100,000 men [1]. The National Cancer Institute adds that Black men with prostate cancer are more likely to die from the disease than white men with prostate cancer [2].

Newer figures, counted against a different comparison group, land in the same place. Using National Cancer Institute data for 2019 to 2023, the Office of Minority Health puts Black men 62 percent more likely than men nationwide, rather than white men specifically, to be diagnosed with prostate cancer, 200.1 against 123.2 cases per 100,000 [3]. For 2020 to 2024, Black men were 92 percent more likely to die of it, 36.2 against 18.9 deaths per 100,000 [3].

Here is the part that catches people out. The Task Force found inadequate evidence to make a separate, specific recommendation for African American men [1]. So the formal guidance is the same for everyone: an individual decision for men aged 55 to 69, and screening not recommended at 70 and over [1]. What the Task Force does say is that a reasonable approach for clinicians is to inform African American men about their increased risk of developing and dying of prostate cancer, along with the potential benefits and harms of screening, so they can make an informed personal decision [1].

That sentence is your opening. The conversation is owed to you, and it may need starting before 55.

What to ask a clinician

• Given my family history and that I am Black, at what age do you think I should start this conversation?
• What is my PSA number, and what was it last time?
• If it is raised, what would you do next, and would you repeat the test before doing anything invasive?
• What are the harms you are weighing here, honestly?
• If we decide not to screen this year, when do we revisit it?

What good care looks like

Good care treats screening as a decision rather than a reflex, and it is honest about what the test does not do. A PSA test or a digital rectal exam may detect prostate cancer at an early stage, but it is not clear whether early detection and treatment lower the risk of dying from prostate cancer [2].

It is also honest about the harms, which the National Cancer Institute lists: finding cancer that may never cause symptoms or become life threatening, complications from biopsy, and both false-negative and false-positive results that lead to unnecessary anxiety and further testing [2]. PSA can also be raised by prostate infection, inflammation or benign enlargement [2].

Good care does not stop at the decision to screen. The Task Force says the higher death rate among African American men may in part reflect lower rates of receiving high-quality care, and it calls for work to continue on eliminating disparities in access to that care [1]. Follow-up is where the mortality gap widens. A raised PSA with no plan attached to it is not screening, it is a loose end.

When it is urgent

Screening is for men without symptoms. Symptoms need an appointment now, not a screening conversation later: trouble starting or stopping urine, a weak stream, needing to pass urine often at night, blood in the urine or semen, new pain in the back, hips or pelvis that will not settle, or unexplained weight loss.

Being unable to pass urine at all is an emergency, not a phone call.

What to do next

Book the conversation, not just the test. Take your family history with you, specifically any father, brother or uncle diagnosed with prostate cancer and how old they were.

Start with a primary care doctor, and see Black urologists if the PSA is raised or symptoms are present. If a cancer is found, Black oncologists are listed here too. Ask at every step what the next appointment is and who books it.