Prostate check-ups and PSA questions

Many men reach their 50s unsure what a “prostate check” involves, whether they need a PSA test, and what a result means. This guide explains the basics so you can have an informed conversation with your doctor. It is not a substitute for that conversation.

What PSA is and what it is not

PSA (prostate-specific antigen) is a protein made by the prostate and measured with a blood test. A higher level may be a sign of prostate cancer, but it is not proof: an enlarged prostate (BPH), inflammation and certain medicines can also raise PSA, and a low PSA does not guarantee that cancer is absent (MedlinePlus). A doctor may also do a digital rectal exam to feel the prostate.

Benefits and trade-offs of screening

Screening can find some cancers earlier, when they may be easier to treat. But the National Cancer Institute notes that about 6% to 7% of men have a false-positive PSA result in any screening round, that only about a quarter of men biopsied for a raised PSA are found to have cancer, and that some screen-detected cancers grow so slowly they would never have caused harm (overdiagnosis). Treatment of those cancers can cause urinary, bowel and sexual side effects (NCI).

For men aged 55 to 69, the US Preventive Services Task Force recommends an individual decision after discussing benefits and harms with a clinician; it does not recommend PSA-based screening for men 70 and older. Men at higher risk, including Black men, men with a father or brother who had prostate cancer, and men with inherited BRCA2 (and to a lesser extent BRCA1) variants, may consider starting the discussion around age 40 or 45 (NCI).

Questions to bring to your appointment

• Based on my age, family history and health, what are my personal benefits and risks of PSA screening?
• If my PSA is raised, what are the next steps, and could anything else explain it?
• How often should I be tested if I choose screening?
• Do any of my medicines or supplements affect my PSA or my urinary symptoms?

Healthy habits and where supplements fit

Staying active, keeping a healthy weight, not smoking and eating plenty of vegetables, fruit and whole grains support overall health and may help with urinary symptoms. No supplement has been shown to prevent prostate cancer. Some may even cause harm: in the SELECT trial, men who took 400 IU of vitamin E daily had a higher risk of prostate cancer than men taking placebo (Klein et al., 2011). Pomegranate did not lower PSA in a placebo-controlled trial (Stenner-Liewen et al., 2013), and saw palmetto does not change PSA levels, even at high doses (Andriole et al., 2013).

Always tell your doctor which supplements you take before a PSA test, and never use a supplement in an attempt to change a PSA result. Testosterone-raising herbs such as ashwagandha deserve particular caution if you have prostate cancer or a rising PSA (NCCIH).