SUMMARY:
The key thing to know about prostate cancer is the importance of early detection. In its early stage, prostate cancer has no symptoms, but annual screening picks up the earliest hint. Further noninvasive tests will detect cancer presence. If found, a diagnostic biopsy will confirm its location and stage. If found early enough, tailored treatments offer nearly 100% success with fewer side effect risks.
What’s the key thing to know about prostate cancer?
The most important thing to know about prostate cancer is this: early detection saves lives. Detecting it in a timely manner means catching it while it is still contained in the gland. This is called localized prostate cancer, meaning it has not yet begun to spread.
Localized prostate cancer is basically the simplest prostate cancer to treat with curative intent. That’s because, as Dr. Dan Sperling puts it, local treatments can be tailored to the extent of the tumor. Local treatment with curative intent has a 5-year survival rate of over 99%.
However, early prostate cancer is difficult to detect because it has no symptoms. Thus, it’s essential that men participate in an annual screening program to facilitate early detection. Dr. Sperling speaks from years of clinical experience when he declares that “annual PSA testing is essential because it saves lives.”
Why do many men skip or avoid annual screening?
Many men may not realize that annual screening can avoid missing a crucial treatment window. The Prostate Cancer Foundation states that “… too many men don’t ask their doctor about prostate cancer screening—out of fear, misunderstanding, or simply not knowing it’s a crucial piece of their health.”
This fear, misunderstanding, or not knowing began about 2012 when the US Preventive Services Task Force (USPSTF) downgraded the PSA screening test. They did so because countless men whose screening was suspicious for prostate cancer were quickly sent for a needle biopsy. unintended harm.
The type of biopsy done back then often led to unintended harm. It had side effects, and a 15-46% rate of false negatives.[i] In turn, positive biopsies often led to aggressive overtreatment for low-risk prostate cancer. Though treatment success rates were high, countless men were left with long term urinary, sexual or bowel problems.
Thus, after 2012 the number of men having an annual PSA test began to drop. By 2023, only 38.0% of men aged 55-69 years had a PSA test within the past year. Meanwhile, many early treatment windows were missed because men weren’t screened. They missed early detection, so by the time symptoms occurred, many already had advanced prostate cancer that was no longer considered curable.
How does an annual PSA test screen for prostate cancer?
“Screening” means finding clues that a disease is present before symptoms occur. For prostate cancer, the PSA test is a simple screening blood test. PSA stands for Prostate Specific Antigen, a protein that prostate cells “shed” into the bloodstream. The purpose of the blood test is to measure the PSA level.
When nothing unusual is disturbing a healthy prostate, the PSA level will be low. At around age 45-50, it’s good to have the first PSA test to establish the individual’s normal baseline for his age. The Mayo Clinic summarizes standard normal PSA values at each age:
| Age | Average normal upper PSA limit (ng/mL) |
| Under 40 | 2.0 |
| 40–49 | 2.5 |
| 50–59 | 3.5 |
| 60–69 | 4.5 |
| 70–79 | 6.5 |
| 80 and above | 7.2 |
NOTE: from age 40 on, it is normal for PSA to gradually rise because the prostate tends to enlarge as a man grows older. This is due to a noncancerous condition called benign prostatic hyperplasia (BPH).
A higher-than-normal PSA is a hint of something unusual. As Dr. Sperling describes, “PSA screening has merit as a warning system, but not as a diagnostic system. An abnormally high PSA test result—or a result that rises over several years—raises a red flag.”
Does a high PSA mean prostate cancer?
No, a high PSA does not automatically mean prostate cancer. It is a signal, but it is not cancer detection. PSA is not specific because other conditions besides prostate cancer can also cause a rise in PSA:
- Benign prostatic hyperplasia (BPH)
- Infection or prostatitis
- Unusual physical activity that stimulates the prostate, e.g. bike riding, orgasm, prostate massage
- Digital rectal exam (DRE)
If screening is not specific, then how is prostate cancer detected?
When a screening PSA result is abnormally high, more specific tests are done to tell the difference between cancer vs. other causes. The two most common are noninvasive.
- A repeat PSA test at least 6 weeks after the first. A repeat PSA rules out things like lab error. Also, the blood sample can be used for additional specific evidence like PSA density[ii] or genomic testing. (NOTE: Do not ride a bike or have sex within 2 days prior to a repeat PSA. If the doctor wants a DRE, it should be done after the blood draw.)
- Multiparametric MRI (mpMRI) to obtain a high resolution, 3-dimensional portrait of the prostate gland and any possible lesion (area that looks like prostate cancer) within it.
If no cancer is detected, prostate cancer is considered ruled out. Other tests may then be done to look for infection/prostatitis, BPH, or some other cause for the suspicious PSA result.
If prostate cancer is detected, what is the next step?
If the combination of a repeat PSA test plus mpMRI detects one or more areas in the prostate that have characteristics of prostate cancer, the next step is a diagnostic biopsy. Thanks to the high detection accuracy of mpMRI, biopsy needles can be targeted into the area (sometimes additional samples will be taken in other prostate sites).
The tissue samples are examined under a microscope. Any cancerous cells that are present are assigned a Gleason score to indicate how aggressive they are. This information, plus the location and extent of the suspicious area along with other relevant factors, will be used to plan a treatment strategy.
Does early detection make a difference in planning treatment?
Early detection can make a significant difference in planning treatment. If prostate cancer is detected early, the odds are it will be diagnosed when it is localized and low-risk. Local treatments with intent to cure ranges from radical (whole gland) treatment by surgery, radiation or ablation, to various methods of minimally invasive precise focal therapy. For example, Dr. Sperling offers Focal Laser Ablation.
Just remember that early detection is the most important thing to know about prostate cancer. It’s the key to a range of treatment choices with highest chance of success and the least risk of side effects.
FAQ: Prostate Cancer
Q: What kinds of tests are used to diagnose prostate cancer?
A: Typical tests to detect prostate cancer include blood work (PSA, PSA density), multiparametric MRI with PI-RADS score. By detecting prostate cancer, they set the stage for diagnosis. A needle biopsy is still the only way to diagnose prostate cancer, though findings from the other tests give additional important information that adds value to the biopsy results. Depending on all findings, additional tests may be ordered, e.g. genomic analysis and PSMA-PET scan.
Q: Why is a needle biopsy necessary?
A: The only way to obtain a definitive prostate cancer diagnosis is to take tissue samples for examination under a microscope. A needle biopsy is necessary so live cancer cells can be evaluated by a specialist. This allows assigning a numeric score to indicate how aggressive the cells appear. Also, the amount of cancer and normal tissue in each needle helps assess the extent of the cancer. Finally, the location of each needle that is positive for cancer helps define the location and shape of the tumor. Coupled with the MRI imaging, the tumor and its characteristics determine the treatment plan.
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] Descotes JL. Diagnosis of prostate cancer. Asian J Urol. 2019 Apr;6(2):129-136. doi: 10.1016/j.ajur.2018.11.007. Epub 2019 Feb 14.
[ii] Tosoian JJ, Druskin SC, Andreas D, Mullane P et al. Prostate Health Index density improves detection of clinically significant prostate cancer. BJU Int. 2017 Dec;120(6):793-798.
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.
