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.

It’s one of the most common questions men ask when they’re told they have an enlarged prostate:

“Can BPH turn into prostate cancer?”

The short answer is no — but understanding the difference between the two conditions can ease a lot of worry and help you make informed decisions about your health.

BPH and Prostate Cancer: Different Conditions, Same Organ

Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland. It’s caused by normal hormonal changes that come with age and affects the part of the prostate surrounding the urethra — the channel that carries urine out of the body. As the gland grows, it can press on the urethra and cause symptoms such as:

• A weak or interrupted urine stream
• Frequent or urgent need to urinate
• Getting up several times at night to urinate (nocturia)
• Difficulty starting urination

Prostate cancer, on the other hand, is made up of regular prostate cells that, for reasons that are unclear, begin to grow and divide uncontrollably. These cells look different from healthy ones and form a tumour.

Usually, prostate cancer starts at the outer edge of the prostate and grows inward, whereas BPH begins in the central area around the urinary passage and grows outward. Depending on the size and location of the cancer, there may be no symptoms at all (sometimes it’s detected only because of a high PSA) – or symptoms can mimic those of BPH.

If not detected early, prostate cancer can spread locally, just outside the prostate, or further away to the lymph nodes, bones, liver, or other areas (a process called metastasis).

Can One Lead to the Other?

Although BPH and prostate cancer can occur at the same time, one does not cause the other. Having BPH does not increase your risk of developing prostate cancer. However, because both conditions affect the same organ and may cause overlapping urinary symptoms, it’s important to distinguish between them through proper testing.

Why Testing Matters

Even though BPH is benign, similar symptoms – such as frequent urination or difficulty emptying the bladder – can also appear with prostate cancer. That’s why screening is essential.

Your urologist may recommend:

• A PSA (Prostate-Specific Antigen) blood test
• A digital rectal exam (DRE)
• Imaging or, in some cases, a prostate biopsy

These tools help identify whether your symptoms are caused by BPH, prostate cancer, or — in some cases — both conditions occurring together.

Note: having BPH does not cause cancer; but because both are common in aging men, they can sometimes be present simultaneously.

Managing BPH

If your tests confirm BPH, several minimally invasive treatments are available — including Rezūm, iTind, and Optilume. Each works differently to relieve urinary symptoms and improve quality of life without major surgery. The choice of treatment depends on several factors, which your urologist will discuss with you in detail to ensure the best fit for your needs and goals.

The Bottom Line

BPH and prostate cancer are two separate conditions. BPH does not turn into cancer, but the symptoms can be similar — so evaluation by a urologist is the only way to know for sure.

If you have questions about your test results, our specialists at University Urology Associates will review your findings, explain your options, and guide you toward relief with clarity and confidence.

Book a consultation or complete our 4-question BPH quiz to find out whether you may benefit from our minimally invasive treatments.

We are a specialist clinic — not a general urology practice. That means we focus on a defined set of conditions where we can offer deep expertise and access to advanced diagnostic tools and minimally invasive treatments, including Health Canada- and FDA-approved technologies not widely available in Canada.

Our Areas of Focus

BPH (Enlarged Prostate) — Minimally Invasive Surgical Therapies (MISTs)

For men who have been evaluated by a physician and diagnosed (or strongly suspected) with BPH, we assess eligibility for office-based treatments designed to improve urinary symptoms without major surgery. Options include minimally invasive procedures such as Rezūm, iTind, and Optilume (when appropriate).

Prostate Cancer Diagnostics

When further investigation is needed after prior assessment (e.g., elevated or rising PSA, concerning imaging), we perform transperineal prostate biopsies, including MRI fusion-guided and systematic TRUS-guided approaches. The goal is accurate, targeted sampling to clarify the diagnosis and guide next steps.

Prostate Cancer Evaluation & Second Opinion

When further investigation is needed after prior assessment (e.g., elevated/rising PSA or concerning imaging), we perform transperineal prostate biopsies — including MRI-fusion–guided and systematic TRUS-guided approaches — to provide accurate, targeted sampling and guide next steps.

Prostate Cancer — Minimally Invasive Treatments

For eligible patients with localized prostate cancer, we offer focal, minimally invasive treatments including HIFU (High-Intensity Focused Ultrasound) and IRE (NanoKnife™). Suitability depends on clinical criteria, imaging, and biopsy findings.

Urethral Strictures — Minimally Invasive Treatment

We manage anterior urethral strictures with endoscopic, minimally invasive techniques, including drug-coated balloon dilation (e.g., Optilume) where indicated. Treatment selection is individualized to stricture characteristics and prior therapy.

Cosmetic (Adult) Circumcision

Outpatient adult circumcision performed in a clinical setting with local anesthesia, focusing on function, comfort, and cosmetic outcome.

Vasectomy

Outpatient vasectomy under local anesthesia for permanent contraception, with a straightforward, clinic-based recovery.

Staying Focused on What We Do Best

We concentrate exclusively on:

• Prostate health
• PSA evaluation and prostate biopsies
• Minimally invasive treatments for localized prostate cancer
• Minor surgical procedures such as vasectomy and adult circumcision
• Minimally invasive treatment of anterior urethral strictures

We do not offer general urology services or treatments outside of this defined area of care. If your concern falls outside our scope, we recommend speaking with your family doctor or seeking care through a general urologist.

How to Get Started

UUA is appointment-based (no walk-ins). To begin, please complete our secure pre-screening form so we can determine fit and whether a consultation can be offered.

Start Pre-Screening Now