Most screening tests come with a simple instruction: get it on schedule. The PSA test for prostate cancer is different. Federal guidance asks men in a certain age range to decide for themselves, after a real conversation with their doctor. That can feel like being handed homework, but the reasons behind it are worth understanding.

What the PSA test measures

PSA, or prostate-specific antigen, is a protein made by the prostate. The blood test measures how much is circulating. Higher levels can occur with prostate cancer, but the CDC notes that PSA is also affected by age, an enlarged prostate, infection, certain procedures and certain medicines. The National Cancer Institute adds that inflammation and benign prostatic hyperplasia, a common noncancerous enlargement, can both raise the number.

So a high PSA is a reason to look further, not a diagnosis. The usual next steps are repeating the test, sometimes imaging, and in some cases a biopsy.

What the guidelines say

The U.S. Preventive Services Task Force’s current recommendation, from 2018, says:

  • Men aged 55 to 69: the decision to have PSA screening should be an individual one, made after talking through the benefits and harms with a clinician.
  • Men 70 and older: the Task Force recommends against routine PSA screening.

The Task Force has an update in progress, but as of October 2026 no new draft has replaced the 2018 statement. Other medical groups publish their own advice, and the CDC notes that recommendations differ between organizations. The Task Force also does not recommend the rectal exam as a screening test, because evidence of benefit is lacking.

The numbers behind the decision

The Task Force estimated what happens when 1,000 men aged 55 to 69 are offered PSA screening over about 13 years. Seeing the figures side by side explains why it is a judgment call:

  • About 240 get at least one positive PSA result, many of them false alarms.
  • About 220 have at least one biopsy.
  • About 100 are diagnosed with prostate cancer, and about 65 receive surgery or radiation at first.
  • About 3 avoid cancer that spreads, and about 1.3 avoid dying of prostate cancer.

The harms are real too. Some cancers found by screening would never have caused symptoms in a man’s lifetime, which is called overdiagnosis. Biopsies can cause bleeding, pain and infection. The Task Force reports that among men treated, about 1 in 5 who have surgery develop long-term urinary incontinence and about 2 in 3 develop long-term erectile dysfunction.

One thing has changed the balance in recent years. More men with low-risk cancer now choose active surveillance: close monitoring with regular tests, and treatment only if the cancer shows signs of changing. The Task Force noted that its use rose from about 10 percent of low-risk cases in 2005 to 2009 to about 40 percent in 2010 to 2013. Finding a slow cancer no longer has to mean immediate surgery.

Who has higher risk

The CDC lists the main risk factors as:

  • Age. Risk rises as men get older.
  • Being Black or African American. Black men are more likely to get prostate cancer, to get it younger, and to die from it. The Task Force notes they are more than twice as likely as white men to die of it.
  • Family history. A father, brother or son with prostate cancer raises risk. Relatives with breast, ovarian or pancreatic cancer can point to an inherited gene change.

Men at higher risk may weigh the decision differently, and some may want to talk about it before 55.

Questions worth asking

  • Given my age, health and family history, how much would screening likely help me?
  • If my PSA comes back high, what would happen next, step by step?
  • Do any of my medicines or conditions affect the result?
  • If a low-risk cancer were found, would active surveillance be an option?
  • If I decide against screening now, when should we revisit it?

Urinary symptoms are a separate matter from screening. Trouble starting, a weak stream, getting up often at night, or blood in the urine or semen deserve a visit whatever your screening choice. Our article on how often you should urinate covers what is typical.

At Legacy Medical, appointments leave room for this kind of decision, and labs including PSA are drawn in the office if you choose to test. Dr. Shtern can walk through your own risk and results at the annual executive physical. If you would like to meet her first, the first visit is a complimentary meet and greet.

This article is general information, not advice for your situation. Members can call the office with questions about their own care.