Special Report: Tips for PCPs on evaluating prostate cancer risk

In this Special Report from Urology Times®, Michael S. Cookson, MD, MMHC, FACS, and Kelly L. Stratton, MD, FACS, discuss how primary care providers can address patient questions on prostate cancer screening. In the context of heightened public awareness around prostate cancer, particularly following former President Joe Biden’s diagnosis, primary care providers are increasingly likely to encounter questions about screening. Stratton emphasizes the importance of shared decision-making between physicians and patients when discussing prostate cancer screening. The primary tool for screening is the prostate-specific antigen (PSA) test, and in some cases, a digital rectal exam may also be appropriate. Stratton notes that primary care physicians play a critical role in initiating this conversation, assessing symptoms, and setting expectations. If a PSA result is abnormal, referral to a urologist is essential to further evaluate the cause.

Stratton explains that elevated PSA levels do not necessarily indicate cancer. Benign prostatic hyperplasia, urinary tract infections, and inflammation can all elevate PSA. The urologist’s role is to expand the diagnostic process, potentially incorporating imaging such as a prostate MRI before considering a biopsy. This imaging can help target suspicious lesions and improve the accuracy of diagnosing clinically significant prostate cancers, minimizing unnecessary procedures and overdiagnosis.

Cookson adds that over 90% of PSA tests are initiated by primary care practitioners or advanced practice providers. He underscores the appropriateness of PSA testing in symptomatic men and highlights the evolving context of screening in asymptomatic individuals. For screening to be beneficial, men should have a life expectancy of at least 10 years. While past guidelines often suggested stopping screening around age 70, current trends reflect increased longevity, and many men in their mid-70s may still be good candidates for screening.

Cookson also notes a shift in clinical practice away from routine biopsies and overtreatment, which were common in earlier decades. Many cases of low-grade prostate cancer, particularly grade group 1, are now managed conservatively without immediate intervention. This more nuanced, individualized approach benefits patients by avoiding unnecessary treatments while still identifying and addressing clinically significant cancers.

Our panelists:

Michael S. Cookson, MD, MMHC, FACS, is a professor and the Donald D. Albers Endowed Chair in Urology at the University of Oklahoma Health Sciences Center in Oklahoma City. He is also a Co–Editor in Chief for Urology Times®.

Kelly L. Stratton, MD, FACS, is an assistant professor of urologic oncology and an adjunct associate professor of medicine at the University of Oklahoma (OU) College of Medicine and the chair of urologic oncology at the OU Stephenson Cancer Center in Oklahoma City. He is also a member of the Urology Times Editorial Council.