At some point, every man reaches an age where ignoring symptoms or “pushing through it” stops being a good plan. Recent research from Stanford suggests that the body ages in distinct waves — one in the mid-40s and another in the mid-60s — which is often when men start noticing changes they can’t dismiss as easily.
Those shifts make prostate health an important part of routine care. For most men, that conversation starts around age 50. For men of African or Caribbean ancestry, or those with a family history of prostate cancer, it begins earlier — often around 40-45.
Regardless of the exact age, the turning point is the same: you start taking your health seriously because staying well is easier than dealing with a problem too late. Prostate health is a key part of that picture. One in 8 men will develop prostate cancer, and roughly 1 in 4 will experience benign prostate enlargement (BPH) as they age.
Here’s what to expect, when to be checked, and how to interpret common test results.
When Should You Start Screening?
Screening isn’t the same as diagnosing cancer.
It’s about checking where you stand and spotting changes early, while they’re easier to manage.
General guidance
- Average risk: Start discussing screening around age 50.
- Higher risk: (African/Caribbean ancestry or first-degree relative with prostate cancer) Consider starting between 40–45.
Your doctor may adjust this based on symptoms, personal history, or previous test results.
What Screening Includes
Screening usually includes two simple steps that give a clear picture of your prostate health.
1. PSA Blood Test
PSA, or Prostate-Specific Antigen, is a protein made by the prostate. Higher levels can signal an issue, but often they don’t. PSA can rise because of:
- benign prostate enlargement (BPH)
- age
- recent ejaculation
- inflammation or infection
- a long bike ride
- recent prostate procedures
This is why a single PSA result rarely tells the whole story. Patterns over time matter more than one number.
2. Digital Rectal Exam (DRE)
A quick exam where your doctor checks the surface of the prostate for firmness, asymmetry, or irregularities. Paired with PSA, it helps give a fuller picture.
How to Understand PSA Results
Low or Normal for Your Age
This is the most common result. It usually means:
- no immediate concern
- follow-up every 1-2 years
- earlier follow-up if you develop symptoms or have higher-risk factors
Mildly Elevated PSA
Common, and often not related to cancer.
Your doctor may recommend:
- repeating the test
- treating a possible infection
- reviewing activities or medications that may affect PSA
- imaging, if the number stays elevated or continues rising
PSA Free-to-Total Ratio
Your PSA has two forms in the blood: “free” PSA and “bound” PSA. The free-to-total ratio compares how much PSA is free versus how much is attached to proteins.
This test is only validated when the total PSA is between 4 and 10 ng/mL. In that range, a lower ratio can suggest the PSA rise needs closer investigation, while a higher ratio often points toward benign causes like BPH.
The ratio doesn’t diagnose cancer on its own, but it gives your doctor another piece of information when deciding whether an elevated PSA is more likely from enlargement, inflammation, or something that needs further assessment.
Rising PSA Over Time
Even if the number isn’t high, a steady increase can still signal that something is changing. A common rule of thumb is this: if your PSA rises by more than 20% over a year, it requires further assessment, even if the number is still in the “normal” range.
When that happens, men are often referred for:
- MRI, which provides detailed imaging
- additional blood or urine tests
- a biopsy, if the MRI or overall picture suggests it’s appropriate
PSA Density
PSA density compares your PSA level to the size of your prostate.
A larger prostate naturally makes more PSA, which means a PSA that looks “high” may actually be normal for you.
Prostate size can only be measured by ultrasound or MRI, not by a DRE.
Very High PSA
A very high PSA requires further investigation, but it still doesn’t automatically mean cancer. It simply means that more information is needed to understand what’s going on.
When MRI Becomes Important
Not all centres use the same type of prostate MRI.
At University Urology Associates, we rely on multiparametric MRI, which provides a more detailed look at the prostate than standard imaging.
An mpMRI can help identify:
- suspicious or abnormal areas
- the size and shape of the prostate
- signs of inflammation or infection
- whether a biopsy is recommended
It helps avoid unnecessary procedures and offers clearer answers early on.
If You Need a Biopsy
Not every elevated PSA leads to a biopsy. If your doctor recommends one, they’ll explain why and walk you through the steps.
Most centres take biopsy samples through the rectum. At University Urology Associates, the approach is different. We use a transrectal ultrasound probe for guidance, but the biopsy needles are inserted through the perineum. The perineum is the space between the rectum and the base of the scrotum, so the needles do not go through the rectum or through the scrotum.
This technique reduces infection risk and allows your urologist to target specific areas more accurately.
Why This Matters
Prostate screening doesn’t have to feel complicated.
Getting checked after 50 – or earlier if you’re at higher risk – is a straightforward way to protect your long-term health.
Most men find that:
- their PSA is normal,
- or the result simply needs monitoring,
- or, if something needs attention, it’s treatable easier when detected early
If you’d like to know whether a biopsy is appropriate for you based on your PSA and other factors, you can start with our pre-screening form. Our team will review your information and guide you toward the right next step.