Risk factors
The exact cause of prostate cancer is unknown. Prostate cancer risk is influenced by several factors. Having one or more risk factors does not mean you will develop prostate cancer. It simply means you may benefit from a more personalized plan for early detection with your healthcare provider.
Age: Risk increases with age, especially after age 50.
Race: Black or African American men are more likely to be diagnosed with prostate cancer and more likely to die from the disease.
Family history: Risk is higher if a close relative has had prostate cancer. A family history of breast, ovarian, colorectal, pancreatic, or endometrial cancer can also increase risk, especially when cancers occur at younger ages.
Inherited genetic mutations: Inherited mutations such as BRCA1, BRCA2, HOXB13, ATM, and other genes can increase the risk of prostate cancer in some families. Genetic risk can also affect how screening is approached.
Occupational and chemical exposures: Some exposures may be associated with higher risk. This can include veterans with Agent Orange exposure and certain occupations with repeated chemical or carcinogen exposure, including firefighters, first responders, pilots, and agricultural workers.
Symptoms
Many men have no symptoms in the early stages of prostate cancer. That is one reason early detection can be important. Urinary symptoms are common in men as they age and are often caused by benign prostate enlargement, not cancer. Still, new or worsening symptoms should be discussed with a healthcare provider.
Symptoms that may occur
- No symptoms, especially early on
- Frequent urination, especially at night
- Weak urinary stream
- Trouble starting urination or fully emptying the bladder
- Stopping and starting during urination
- Pain or burning during urination
- Blood in the urine or ejaculate
- Persistent bone pain, such as hips, ribs, or back
- Unexplained weight loss or fatigue
Screening and early detection
Early detection is a shared decision between a man and his healthcare provider. Screening does not diagnose prostate cancer. It helps estimate risk and determine whether follow up is needed.
Early detection commonly uses a prostate specific antigen, PSA, blood test. A digital rectal exam, DRE, is optional and is often used when PSA is elevated, when symptoms are present, or when a clinician feels it is appropriate.
View PCEC screening guidance PDF
PSA blood test
PSA is a protein made by the prostate. PSA is prostate specific, but it is not cancer specific. PSA can rise from many causes, including benign prostate enlargement, inflammation, infection, recent ejaculation, recent cycling, or recent procedures. PSA results should be interpreted in context, and trends over time often matter more than a single number.
Baseline PSA at age 45
PCEC recommends that men obtain a baseline PSA blood test at age 45. This baseline helps guide how often future testing may be needed.
PCEC PSA monitoring guidance
PSA less than 1.5 ng per mL
Most men are considered lower risk. Repeat PSA every 2 to 4 years, unless additional risk factors suggest closer follow up.
PSA 1.5 ng per mL or higher
This does not mean cancer. It may indicate a prostate health condition or a higher risk level. Repeat PSA and discuss next steps with a healthcare provider.
Higher risk groups
Some men may benefit from earlier or more frequent discussions about screening and follow up. This can include men who are Black or African American, men with a strong family history of related cancers, men with known inherited genetic mutations, and men with certain occupational exposures.
What happens if PSA is elevated
An elevated PSA does not automatically mean a biopsy is needed right away. A clinician may recommend a repeat PSA, additional blood or urine testing, imaging such as prostate MRI, and in some cases genomic or biomarker tests to better estimate risk and decide whether biopsy is appropriate.
Additional PSA related tests
- Percent free PSA
- PSA density
- PSA velocity
- PSA doubling time
- Prostate Health Index, PHI
When screening may not be helpful
PCEC does not recommend early detection in men who have significantly decreased life expectancy due to other serious health issues and have no signs of prostate cancer or other prostate conditions. This is a discussion to have with your healthcare provider.
Digital rectal exam, DRE
A DRE is a quick exam in which a clinician feels part of the prostate through the rectum to check for firmness, lumps, or other changes. The entire prostate cannot be felt during a DRE, but it can provide useful information in selected situations.
Prevention and healthy lifestyle
No lifestyle change can guarantee prevention of prostate cancer. However, healthy habits may help reduce risk and support overall health.
- Maintain a healthy weight through nutrition and regular physical activity
- Limit red and processed meats and choose lean proteins more often
- Emphasize fruits, vegetables, whole grains, and healthy fats
- Discuss calcium intake with your clinician and avoid unnecessary high dose supplements
- Do not smoke and limit alcohol if you drink
- Use supplements cautiously and avoid doses above recommended daily allowances unless advised by a clinician