Prostate cancer increases with age, especially after age 50. It is the second-leading cause of cancer-related death in men.
Symptoms don't typically appear until more advanced stages of the disease, making prostate cancer screening very important.
Lifestyle factors such as diet, weight, and smoking status don't appear to be as definitive of risk factors when compared to other diseases, like cardiovascular conditions and Type 2 diabetes.
Prostate cancer can be caught early thanks to robust blood screening and newer technology, right here in Northern Michigan.
As men age, joint and spine conditions, cardiovascular health, and metabolic concerns can start to take center stage. Factors like slowed activity, pain and tingling, shortness of breath, or even genetically linked health issues can prompt men to seek care.
But unless urinary or sexual health becomes an issue, one critical health marker many men can overlook is prostate health—including one of the most prevalent forms of cancer in men: prostate cancer.
Prostate cancer occurs when abnormal cells within the prostate gland multiply and form a slow-growing tumor. Over 300,000 (about 1 in 8) men in the U.S. are diagnosed each year, around age 67 on average. Second only to lung cancer, prostate cancer is a leading cause of cancer-related death in men. The good news is that it's typically highly treatable when detected early. Knowing your risk factors, recognizing potential symptoms, and knowing when to screen can help you make informed decisions.
What Are the Symptoms of Prostate Cancer?
Like many forms of cancer, prostate cancer often develops in early stages without clear warning signs.
"The biggest misconception men have is expecting to see symptoms—but early prostate cancer often has no symptoms, and by the time they do develop, the disease may be more advanced," shares Urologist Emily Stevens, MD, who specializes in men's health, urinary incontinence, and general urology at Munson Healthcare.
Once symptoms do start to show up, they often mimic other prostate conditions, and while troublesome, don't automatically indicate cancer. These symptoms can include:
Frequent urination
Difficulty urinating
A weak urine stream
Blood in urine or semen
Erectile dysfunction
Persistent pain in the hips, back or thighs
Unexplained weight loss or fatigue (often in advanced prostate cancer)
Catching Prostate Cancer Early
Without detectable symptoms, prostate cancer can progress to more advanced stages under the radar. While it is rarely detected in men under 40, the risk increases significantly about a decade later, with 6 in 10 prostate cancers affecting men ages 65 and older. For most men, the conversation about screening begins before symptoms ever appear.
"Many cases are discovered through routine screening rather than because a patient noticed a problem,” Dr. Stevens says. "Since this disease often develops quietly at first, routine screening is critical."
Stevens and her Munson colleagues follow guidelines from the American Urologic Association, which recommends routine screening around age 45-50, unless there's an increased risk. Then screening may begin earlier—around age 40-45. In her own practice, Stevens is encouraged by the growing number of men who prioritize screening.
“We're seeing a greater awareness among men that prostate cancer screening is something they should discuss with their physician rather than simply ignore,” she says. "At the same time, screening and diagnosis have become much more sophisticated."
Screening: What to Expect
What's Involved
Fortunately, prostate cancer screening has evolved into a simpler, less invasive method over the past decade.
"You may have heard from an older family member or loved one that screening includes a digital rectal exam (DRE), but that's no longer always the case," Stevens says. "Blood-based testing, called prostate-specific antigen (PSA) screening, was added to the screening protocol in the mid-1990s. Today, a PSA test is typically the first step, and a physical exam may be recommended based on individual symptoms, risk factors, or test results."
PSA screening works by detecting elevated levels of a certain protein produced by the prostate. A higher PSA result can be indicative of prostate cancer—though not always.
"With advances in screening, we're not just looking at a PSA number and automatically sending every man for a biopsy. When a PSA is elevated or there's another reason for concern, we now have more tools to help determine who needs a biopsy and identify suspicious areas," Stevens explains.
Close-to-Home Screening
For patients in Northern Michigan, one of the biggest changes in screening is access to advanced imaging and diagnostic technology close to home. Munson Healthcare uses gold standard 3T (3 Tesla) MRI technology that allows high-quality, detailed images of the prostate.
"This technology helps identify areas that are suspicious for clinically significant prostate cancer and, when appropriate, use that information to guide a more targeted biopsy. It gives us a much better picture of what's happening within the prostate and helps us make more informed decisions about diagnosis and treatment," Stevens says.
For men who schedule their yearly wellness exam, prostate cancer screening is often bundled alongside other lab work, such as complete blood count and metabolic panels, making it even more convenient. Most insurance plans, including Medicare, provide coverage for PSA screening, though coverage may vary based on age, risk factors, and individual plan benefits. Patients should check with their insurer for specific coverage details.
"Early detection can make a tremendous difference because prostate cancer is often most treatable when it is still confined to the prostate. When we identify an aggressive cancer early, we have a better opportunity to treat it before it spreads," Stevens shares, pointing to the 99% five-year survival rate in early-stage prostate cancer.
"The goal of screening isn't simply to find cancer as early as possible. It's to find the cancers that are important to find early, while avoiding unnecessary testing and treatment for cancers that are unlikely to cause harm. That's why having a conversation with your physician about your individual risk and when to begin screening is so important," she emphasizes.
Diagnosis and Treatment
If your PSA levels are elevated over time, your provider will assess the contributing factors that may be increasing your number, including:
Increased cardio activity
Certain medications (such as statins)
Older age
A prostate-related infection or inflammation
Enlarged prostate (non-cancerous)
While the PSA is used for initial screening, follow-up diagnostic testing, including an MRI, may be needed. If cancer is detected, treatment recommendations depend on several factors, including the cancer's stage, grade, growth rate, age, and overall health of the patient.
"Early detection doesn't necessarily mean that every man needs aggressive treatment. If we identify a low-risk cancer, we may be able to monitor it closely through active surveillance and avoid or delay treatment when it's appropriate," Stevens says.
Surgery, radiation therapy, and hormone therapy are commonly used modalities if treatment is needed. Many men continue to work, exercise, travel, and enjoy active lives during and after treatment.
Who is Most at Risk?
Older men (over age 50) and especially men over 65 are at increased risk for prostate cancer. But age alone is just one part of the picture, and most men won't develop prostate cancer.
Other risk factors include:
Ethnicity. African American and Caribbean men (of African ancestry) experience higher rates of prostate cancer, while Hispanic, Latino, and Asian American men are at lower risk.
Family History. Most prostate cancers occur in men with no family history of the disease. However, prostate cancer appears to have a genetic component. A man whose father or brother has been diagnosed with prostate cancer has more than double the risk of developing it. That risk increases with multiple family member diagnoses.
Genetics. In a small number of prostate cancers, genetic mutations (such as the BRCA1 and BRCA2 mutations) can increase your risk, as does Lynch syndrome.
Lifestyle. Diet, weight, smoking status, and chemical exposure could all influence your risk, though studies are not yet definitive. For example, smoking, high consumption of calcium (both food and supplement based), and exposure to arsenic or agent orange may be linked to an increased risk, but more studies are needed. Obesity does not appear to play a role, though findings are not consistent.
Preventive Steps
Unlike some cancers, there is no guaranteed way to prevent prostate cancer. However, maintaining a healthy lifestyle may support overall health and may help reduce the risk of certain cancers and chronic diseases. The following steps can help you lead a fulfilling, active life while keeping diseases in check:
Maintain a healthy weight
Stay physically active
Eat a balanced diet rich in fruits and vegetables
Avoid tobacco products
Keep up with recommended preventive care and wellness visits
"Because prostate cancer often develops without noticeable symptoms, understanding your personal risk factors is key. Regular wellness visits, healthy lifestyle habits, and conversations about screening can help you stay informed and catch potential concerns early," Stevens notes.
Not sure where you stand? Whether you're thinking about your own health or encouraging a loved one to get checked, a conversation with your primary care provider is the first step in understanding prostate cancer risk and the benefits of screening.
