Why PSA Screening Still Matters
Prostate cancer screening remains one of the simplest and most powerful tools in cancer prevention. “When patients ask me what’s the one thing I can do to reduce the chances I will die of prostate cancer,” says Dr. Stephen Freedland, urologist at Cedars-Sinai Medical Center, “the best data we have now say: get that PSA test on a regular basis.”- PSA screening remains the most effective way to prevent death from prostate cancer, allowing doctors to detect disease early and tailor care appropriately.
- Modern screening is smarter and more precise, helping identify cancers that need treatment while avoiding overdiagnosis and overtreatment.
- Advances like PSMA PET-CT imaging are improving how doctors assess spread and personalize treatment once cancer is suspected or diagnosed.
- Current guidelines from the U.S. Preventive Services Task Force recommend men between 55-69 consult with their doctors about the benefits of periodic prostate-specific antigen (PSA)-based screening. The American Cancer Society encourages men with a familial history of cancer or other increased risk to consider PSA testing before age 55.
Why PSA Screening Still Matters
Prostate cancer screening remains one of the simplest and most powerful tools in cancer prevention. “When patients ask me what’s the one thing I can do to reduce the chances I will die of prostate cancer,” says Dr. Stephen Freedland, urologist at Cedars-Sinai Medical Center, “the best data we have now say: get that PSA test on a regular basis.”- PSA screening remains the most effective way to prevent death from prostate cancer, allowing doctors to detect disease early and tailor care appropriately.
- Modern screening is smarter and more precise, helping identify cancers that need treatment while avoiding overdiagnosis and overtreatment.
- Advances like PSMA PET-CT imaging are improving how doctors assess spread and personalize treatment once cancer is suspected or diagnosed.
- Current guidelines from the U.S. Preventive Services Task Force recommend men between 55-69 consult with their doctors about the benefits of periodic prostate-specific antigen (PSA)-based screening. The American Cancer Society encourages men with a familial history of cancer or other increased risk to consider PSA testing before age 55.
Why Prostate Cancer Screening Still Saves Lives
For all the advances in prostate cancer treatment, one truth remains remarkably consistent: screening remains the most effective way to prevent death from the disease. Prostate cancer is highly treatable when detected early, yet it is still one of the leading causes of cancer-related deaths among men. In fact, 1 in 8 men will be diagnosed with prostate cancer. The challenge is not a lack of medical innovation—it is ensuring men get screened in a thoughtful, informed, and timely way.“When patients ask me what’s the one thing I can do to reduce the chances I will die of prostate cancer,” says Dr. Stephen Freedland, urologist at Cedars-Sinai Medical Center and professor of urology, “the best data we have now say: get that PSA test on a regular basis.”
Read MoreThe PSA Test: Simple, Accessible, and Meant to Guide—not Alarm
The prostate-specific antigen (PSA) test is a routine blood test that measures a protein produced by the prostate. While PSA is often discussed as a single number, clinicians interpret it in context rather than as a standalone trigger for treatment. “One of the questions I get asked a lot is, what’s the best way to screen for prostate cancer?” Dr. Freedland explains. “And clearly the answer is a PSA blood test.”Historically, a PSA below 4.0 was considered “normal,” but modern screening recognizes that PSA exists on a spectrum. Some men with lower PSA levels can still have prostate cancer, while others with higher levels may not. PSA can rise due to benign prostate enlargement, inflammation, infection, or even recent physical activity.
Equally important is how PSA changes over time. A gradual rise may suggest a benign process, while a rapid increase can raise concern for more aggressive disease. Age, prostate size, family history, and overall health all factor into how PSA results are interpreted.
Crucially, an elevated PSA is not a diagnosis. It is a signal that further evaluation may be needed—not an automatic path to biopsy or treatment.
Avoiding Overdiagnosis and Overtreatment
One of the key goals of modern prostate cancer screening is finding the cancers that matter—without overdiagnosing those that don’t.
Many prostate cancers grow very slowly and may never cause symptoms or threaten a patient’s life. Treating every detected cancer aggressively can expose men to unnecessary side effects, including urinary, sexual, and bowel complications.
That’s why PSA screening today is designed to start conversations, not end them. Abnormal results often lead to repeat testing, imaging, or careful monitoring rather than immediate intervention. When cancer is diagnosed, active surveillance—closely tracking low-risk disease without treatment—is now a well-established and widely accepted approach.
Screening, when used correctly, helps doctors distinguish between indolent disease and cancers that truly require treatment.
Rethinking the Rectal Exam
For decades, prostate cancer screening was closely tied to the digital rectal exam. That approach is evolving.
“Historically, we would’ve said yes,” says Dr. Freedland. “But it’s increasingly unclear what the value of rectal exams is in routine screening.”
Today, PSA testing alone often provides enough information to guide screening decisions. Dr. Freedland still offers rectal exams, but many patients decline—and that’s okay.
“PSA is getting us mostly where we need to go,” he says.
Reducing barriers to screening while maintaining thoughtful follow-up helps ensure more men get tested without unnecessary anxiety.
What Happens When PSA Is Elevated?
If PSA levels raise concern, next steps may include repeat PSA testing, additional blood work, or a prostate biopsy. A biopsy allows doctors to examine prostate tissue under a microscope and assess how aggressive a tumor appears.
This step is essential not only for diagnosing cancer, but for determining whether treatment is needed—or whether careful monitoring is the better option.
A New Era of Precision Imaging
One of the most important advances in prostate cancer care is PSMA PET-CT imaging, which has dramatically improved how doctors evaluate disease spread.
PSMA, or prostate-specific membrane antigen, is found in high amounts on prostate cancer cells. A PSMA PET-CT scan uses a tracer that binds to those cells, allowing clinicians to detect even very small areas of cancer that older imaging would have missed.
“We can now find small spots of tumor much earlier than we could historically,” Dr. Freedland says. “And that allows us to target treatment much more precisely.”
PSMA imaging helps identify which patients truly need additional therapy and which do not—further supporting the goal of avoiding overtreatment.
“It really seems like it’s making a big difference in outcomes,” Dr. Freedland notes.
Screening as Prevention—and Starting the Conversation
Prostate cancer screening works because it identifies disease before it becomes dangerous, while modern tools help ensure that treatment is reserved for cancers that truly need it. PSA testing is simple, widely available, and often life-saving when used thoughtfully.
Still, many men don’t talk about screening. They delay the conversation, avoid preventive care, or wait for symptoms that may not appear until the disease is advanced.
Through the SurvivorNet film series Men Beating the Odds, including a powerful PSA awareness campaign featuring NFL Hall of Famer Emmitt Smith, the message is intentionally straightforward: this is simple, this is important, and it can save your life. The campaign underscores that getting a PSA test doesn’t require symptoms, complex decisions, or dramatic changes—just a conversation with your doctor and a routine blood test.
The goal isn’t to find every cancer—it’s to find the right ones, at the right time, and treat them in the right way.
When To Get Screened
Current guidelines on screening differ slightly. The U.S. Preventive Services Task Force (USPSTF) recommends men between 55-69 consult with their doctors about the benefits of periodic prostate-specific antigen (PSA)-based screening. Since 2018, the USPSTF has recommended against PSA-based screening for prostate cancer in men 70 years and older.
Meanwhile, the American Cancer Society recommends men, particularly those at potentially higher risk, begin the conversation about PSA screening with their doctors as early as 40-50 years of age:
Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
Age 45 for men at high risk of developing prostate cancer. This includes African American men and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65).
Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).
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