SUMMARY
Men who are concerned about prostate cancer risk often turn to the internet for information. Questions concern symptoms, PSA screening, and general risk factors. This article reviews four of the questions men ask most about prostate cancer.
What do men want to know about prostate cancer?
Today’s men between the ages of 40-75 are more aware of prostate cancer than previous generations were. The media presents constant news: treatment breakthroughs, prominent patients like King Charles and President Biden, the importance of screening, etc.
This awareness sparks questions about prostate cancer, so men frequently turn to the internet for information. What are the warning signs of cancer? What does PSA screening mean, and when should it begin? Am I at risk for prostate cancer? Such questions reflect men’s awareness that if they want to control prostate cancer, it’s better to detect prostate cancer sooner rather than later.
In keeping with this growing consciousness, Dr. Dan Sperling has consistently underscored the importance of regular screening. The Sperling Prostate Center is a leader not only in MRI based early detection of prostate cancer, but also in a Prostate Health and Wellness blog collection that includes awareness of a broad range of men’s health topics.
What are the early symptoms of prostate cancer?
Men want to know about early warning signs, especially because low-risk prostate cancer may not cause symptoms. This is why PSA screening is so vital, as will be discussed below.
Since prostate cancer tumors increase in size, urinary problems are among the earliest warnings. That’s because the urethra (passage for urine from the bladder to the penis) runs through the center of the gland. An enlarging cancer tumor may restrict the flow of urine. Thus, key urinary symptoms include
- Difficulty urinating
- Leaking urine
- Frequent sense of urgency
- Painful or bloody urine
However, other conditions such as a urinary tract infection (UTI) or benign prostatic hyperplasia (BPH) can also cause these symptoms. It’s important to see a doctor for any urinary symptoms.
There are other early warning signs. If prostate cancer escapes from the gland, it has a preference for spread to bones. Bones most affected are the pelvis, spine and ribs. While many things can cause bone or joint pain, discomfort in the hip, back or rib area may be a symptom of prostate cancer that has spread. In any case, bone pain should never be ignored, so consult a physician if this occurs.
Prostate cancer incidence increases as men age, yet other health conditions like arthritis, BPH, erectile dysfunction, cardiovascular disease, etc. also become more prevalent as men age. Therefore, early symptoms of prostate cancer may mimic other problems, and vice versa.
Any unusual health occurrence should always be checked out by a doctor. But where prostate cancer is concerned, don’t wait for symptoms! A simple PSA blood test detects suspicion of prostate cancer.
What is the PSA test, and what do the results mean?
The PSA test is a blood test that measures the amount of prostate specific antigen (PSA) in circulation.
PSA is a protein on the surface of healthy prostate cells as well as prostate cancer cells. It is normal for cells to “shed” these tiny particles into circulation. However, anything that stimulates the prostate gland, or makes it bulkier, can cause greater amounts of PSA to enter the bloodstream.
PSA test results are reported as nanograms per milliliter (ng/mL), which means how much PSA (nanograms) is concentrated in a tiny amount of blood (milliliter). For example, a normal PSA test result may be reported as 2.1 ng/mL (2.1 nanograms per milliliter). If more PSA is present, the result will be a higher number.
The problem is, prostate cancer is not the only thing that can cause an unusually high PSA. In other words, the PSA test is NOT SPECIFIC just for prostate cancer.
What other conditions can cause a high PSA test result?
Other conditions can cause PSA to rise. PSA normally tends to rise slowly after middle age due to a noncancerous age-related condition called benign prostatic hyperplasia (BPH). Thus, normal gland enlargement raises PSA but it’s not cancer.
However, a sudden rise in PSA, or a quickly rising PSA (PSA velocity), is a sign that something more active than BPH is present. It could mean an infection or physical stimulation in the past 48 hours such as bike riding or sexual orgasm. Or, it could mean cancer.
In short, a rising PSA can mean several things including suspicion of prostate cancer. Don’t panic. Before rushing into a needle biopsy, more information can be gained by a) repeating the PSA test in six weeks; b) asking the patient about physical activity or sex shortly before the blood draw; c) imaging using multiparametric MRI (mpMRI).
If a repeat PSA and/or mpMRI continue to have suspicious results, a needle biopsy should then be done to gain “yes or no” evidence.
At what age should I start PSA screening for prostate cancer?
PSA screening is very important because early prostate cancer rarely has symptoms. Screening is worth it because early detection may qualify a patient for a less aggressive treatment. Treating prostate cancer in its earliest stage generally has higher success rates, and less aggressive treatments generally come with lower risk of side effects.
The age to start screening depends on a man’s risk factors (detailed below). The American Cancer Society recommends these guidelines:
- 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)
Medicine.net offers this convenient table by age:
| Age Group | Typical PSA Range | High PSA Threshold | Clinical Concern |
| 40–49 years | 0.0–2.5 ng/mL | >2.5 ng/mL | May indicate early prostate changes |
| 50–59 years | 0.0–3.5 ng/mL | >3.5 ng/mL | PSA >4.0 warrants further workup |
| 60–69 years | 0.0–4.5 ng/mL | >4.5 ng/mL | PSA >6.0 is often investigated for cancer |
| 70–79 years | 0.0–6.5 ng/mL | >6.5 ng/mL | PSA >7.0 may prompt imaging/biopsy |
What are risk factors for prostate cancer?
A man’s risk of developing prostate cancer is influenced by several factors that may occur singly or in combinations. Not every risk factor causes prostate cancer, and not all cases were the result of clear risk factors.
Therefore, evaluating personal risk should not rely on internet information. It is best done in conversation with a doctor who can get to know an individual’s personal and family health history, as well as current health status and lifestyle habits.
Is prostate cancer risk linked with age?
Age is the most common risk factor for prostate cancer. Prostate cancer rates increase with age, so it has been called “an old man’s disease.” In general, aging is accompanied by breakdowns in DNA that can lead to cell mutations. Also, aging may bring other health conditions and a weaker immune system so the body is less able to defend itself from cancer.
However, the disease can occur before midlife. In the U.S., there is a growing rate of diagnosis in men ages 35-55, who generally have poorer treatment outcomes.[i] The reasons for this are unclear, though environmental exposure to pollution or other toxins has been hypothesized.
Is prostate cancer an inherited disease?
Prostate cancer has a strong genetic link. Not all prostate cancer cases are inherited, but some do, so genetics has a bearing on prostate cancer risk. Here are some statistics:
Men who have a first-degree relative (father, brother, son) diagnosed with prostate cancer have 2-3 times higher risk of the disease,[ii] and 1.77 times greater odds of being diagnosed with higher-grade prostate cancer.[iii]
Just as important, men who carry certain breast cancer genes are at increased risk. If a man has a first degree female relative (mother, sister) diagnosed with breast cancer, he may carry either BRCA1 and BRCA2 gene mutation. If so, he is at 21% greater risk for developing prostate cancer and 34% greater risk of life-threatening prostate cancer.[iv]
Is race a risk factor for prostate cancer?
It appears that a man’s racial/ethnic heritage affects his risk level for prostate cancer. The National Center for Healthcare Research writes, “Black men are 1.5 times more likely to get prostate cancer than White or Latino men, and 3 times more likely to get prostate cancer than Asians and Pacific Islanders. On average, Black men get prostate cancer at younger ages than other men, and their cancer is often more aggressive and more advanced when it is discovered. Black men are also more than twice as likely to die from prostate cancer than men from other races.”
Experts agree Black men should be screened at earlier ages, yet evidence of biological/genomic difference is not fully established. There are complex reasons including socioeconomic inequities and cultural/geographic influences such as diet and environment. Many studies have demonstrated that equality in healthcare services and deliveries tends to erase disparities in risk.
How do health and lifestyle choices affect prostate cancer risk?
Yes, modifiable lifestyle patterns can lower prostate cancer risk. Much has been written about risk factors that can be modified by making healthier choices. Plant-based diets are linked with lower rates of developing prostate cancer, with slower disease progression for those already diagnosed with cancer, and with other important health benefits.
Diets that are high in fats, sugar and processed foods are associated with chronic inflammatory states as the body’s systems are stressed; in turn, inflammation is linked with higher prostate cancer rates and more aggressive disease.
Regular vigorous exercise is shown to have a preventive effect against prostate cancer and other cancers. Stress management (including meditation and breathwork) can counter chronic inflammatory states. Let’s not forget about quitting smoking and cutting down on alcohol.
Conclusion
Hopefully the above information accomplishes two purposes:
- First, provides assurance that when prostate cancer is diagnosed at an early stage, there is a very high chance of successfully controlling the cancer; and since today’s treatments can be tailored to the disease, less aggressive disease may qualify for a less aggressive treatment with lower risks of side effects.
- Second, encourages readers to have an annual PSA blood test, and a relationship with a primary care doctor with whom any possible risk factors can be discussed.
Keep in mind that a healthy lifestyle offers the best way to age well into a long life, minimizing risks for cancer, cardiovascular disease, and other aging-related conditions.
Frequently Asked Questions
Q: How can I know if I’m at risk for prostate cancer?
A: The best way to assess your risk for prostate cancer is to make a list of the things you’re worried about, write down your questions, and talk with your primary care doctor who has access to your health records. If you don’t already have a primary care doctor whom you see annually, it is recommended that you get one. Meanwhile, have an annual PSA blood draw. Your first test is your baseline, and you can monitor it every year thereafter.
Q: What if my PSA is high or rising?
A: If you have an unusual or atypical PSA result, request a repeat test to rule out lab error. Avoid having sex or riding a bike for 72 hours before the blood draw. Do not have a digital rectal exam before the blood draw, as that can cause a rise in PSA. If the second PSA is still suspicious, the next step should be imaging using multiparametric MRI. If a suspicious area is seen, an MRI-guided targeted biopsy into the area can provide an accurate “yes-or-no” diagnosis.
Content reviewed by Dr. Dan Sperling, M.D., DABR — updated January 2026
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
References
[i] Kratzer TB, Miller KD, Sung H, et al. Prostate cancer statistics, 2025. CA: A Cancer Journal for Clinicians. 2025. doi:10.3322/caac.70028
[ii] Zhang, X., Li, Y., Yan, C. et al. Global trends in testicular and prostate cancer among adolescents and young adult males aged 15–49 years, 1990–2021: insights from the GBD study. Sci Rep 15, 23388 (2025).
[iii] Kratzer, Ibid.
[iv] Barber L, Gerke T, Markt SC, Peisch SF et al. Family History of Breast or Prostate Cancer and Prostate Cancer Risk. Clin Cancer Res. 2018 Dec 1;24(23):5910-5917.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
