National Cancer Prevention Month: Prostate Cancer Screening FAQs for Clinicians

February is National Cancer Prevention Month, a timely opportunity to revisit the role of early detection in prostate cancer. According to the American Cancer Society’s 2026 Cancer Statistics report, prostate cancer is projected to be the most commonly diagnosed cancer among males in 2026 and the second leading cause of cancer-related death. Specifically, the ACS estimates that 333,830 men in the US will be newly diagnosed with prostate cancer in 2026, and 36,320 will die from the disease.¹

The risk of prostate cancer is particularly high for Black men, who experience an incidence rate nearly 70% higher than that of White men. Black men are also 2 to 4 times more likely to die from prostate cancer than men in other racial and ethnic groups.¹

Screening has the potential to reduce prostate cancer mortality, as outcomes are strongly influenced by stage at diagnosis. The ACS reports a 5-year relative survival approaching 100% among the majority (84%) of patients diagnosed with localized or regional disease, compared with 38% for those presenting with distant-stage disease.¹

Against this backdrop, clinicians must navigate when to initiate screening, identify patients at increased risk, and determine when the potential harms of screening and downstream testing may outweigh the benefits.

The American Urological Association (AUA) guideline on the early detection of prostate cancer emphasizes shared decision-making, risk-adapted screening strategies, and more selective use of biopsy and adjunctive testing.^2,3 Drawing on evidence from a systematic review spanning more than 2 decades, the guideline provides a structured framework for clinicians managing individuals without a prostate cancer diagnosis who are undergoing prostate-specific antigen (PSA) screening or evaluation for possible clinically significant disease.

Across screening, initial biopsy, and repeat biopsy settings, the guidance reinforces PSA as the foundation of early detection while discouraging reflexive escalation to biomarkers, imaging, or biopsy without reassessment of risk. The recommendations also clarify the role of MRI, validated risk calculators, and selective biomarker use, with the goal of improving detection of clinically significant prostate cancer while minimizing unnecessary procedures and overdiagnosis.

The following FAQs highlight key guideline recommendations relevant to urologists, advanced practice providers (APPs), and other clinicians.

A full discussion on the recommendations for prostate cancer screening with Adam B. Weiner, MD, can be found here.

1. What is the recommended first step in prostate cancer screening?

Clinicians should engage in shared decision-making with individuals for whom screening is appropriate and proceed based on patient values and preferences. When screening is performed, PSA should be used as the initial screening test.

2. At what age should prostate cancer screening begin?

The guidelines recommend that clinicians begin screening and offer a baseline PSA test to individuals aged 45 to 50 years. For individuals at increased risk—including those with Black ancestry, germline mutations, or a strong family history—screening should be offered beginning at 40 to 45 years.

3. What screening interval is recommended?

Regular prostate cancer screening should be offered every 2 to 4 years to individuals aged 50 to 69 years. Screening intervals may be personalized or discontinued based on shared decision-making, considering age, PSA level, prostate cancer risk, life expectancy, and overall health.

4. How should clinicians manage a newly elevated PSA result?

For individuals with a newly elevated PSA, clinicians should repeat the PSA before proceeding to secondary biomarkers, imaging, or biopsy. This step allows confirmation of PSA elevation prior to further evaluation.

5. Should digital rectal examination still be used in screening?

Clinicians may use digital rectal examination (DRE) alongside PSA to help establish the risk of clinically significant prostate cancer. However, DRE is not positioned as a standalone screening test.

6. Is PSA velocity recommended to guide biopsy decisions?

No. Clinicians should not use PSA velocity alone as an indication for secondary biomarkers, imaging, or biopsy in individuals undergoing screening.

7. When can prostate biopsy be deferred?

Clinicians and patients may forgo near-term prostate biopsy following shared-decision making when the risk of clinically significant prostate cancer is sufficiently low based on available clinical, laboratory, and imaging data. Validated risk calculators may be used to support this decision.

8. When may a prostate biopsy be omitted in patients with markedly elevated PSA?

In patients with a PSA level greater than 50 ng/mL and no clinical concern for infection or another reversible cause of PSA elevation (such as recent prostate instrumentation), clinicians may omit a prostate biopsy in select circumstances. This approach may be appropriate when biopsy poses a significant procedural risk or when there is an urgent need to initiate prostate cancer treatment, such as in the setting of impending spinal cord compression.

9. How should patients be counseled before prostate biopsy?

Patients should be informed that biopsy may identify cancers with a sufficiently low risk of mortality that can be safely managed with active surveillance rather than immediate treatment.

10. What is the role of MRI before an initial prostate biopsy?

Clinicians may use MRI prior to initial biopsy to improve detection of Grade Group (GG) 2 or higher prostate cancer. When multiparametric MRI is performed, radiologists should report findings using PI-RADS.

For biopsy-naïve patients with suspicious MRI lesions, targeted biopsies of the suspicious lesions should be performed, with the optional addition of a systematic template biopsy.

11. How should clinicians approach screening and biopsy after a negative biopsy?

Screening should not be discontinued solely on the basis of a negative biopsy, and PSA thresholds alone should not determine the need for repeat biopsy.

After a negative biopsy, clinicians should reassess risk using tools that incorporate the protective effect of the prior negative biopsy and re-evaluate patients within the standard screening interval or sooner based on risk and life expectancy. Biomarkers and repeat biopsy should be used selectively, only when results are likely to influence management.

REFERENCES

1. Siegel RL, Kratzer TB, Wagle NS, Sung H, Jemal A. Cancer statistics, 2026. CA Cancer J Clin. 2026 Jan-Feb;76(1):e70043. doi:10.3322/caac.70043

2. Wei JT, Barocas D, Carlsson S, et al. Early detection of prostate cancer: AUA/SUO guideline part I: prostate cancer screening. J Urol. 2023;210(1):45-53

3. Wei JT, Barocas D, Carlsson S, et al. Early detection of prostate cancer: AUA/SUO guideline part II: considerations for a prostate biopsy. J Urol. 2023;210(1):54-63