Checking your prostate involves two main screening tools: a blood test that measures a protein called PSA, and a physical exam where a doctor feels the prostate through the rectum. Most men between 55 and 69 should talk with their doctor about whether screening makes sense for them, while men at higher risk may benefit from starting the conversation earlier.
The Two Main Screening Methods
A PSA test is a simple blood draw. Your prostate naturally produces a protein called prostate-specific antigen, and the test measures how much of it is circulating in your blood. Higher levels can signal prostate cancer, but they also rise with non-cancerous conditions like an enlarged prostate or an infection. That’s an important distinction: an elevated PSA does not automatically mean cancer.
The other tool is a digital rectal exam, or DRE. A doctor inserts a gloved, lubricated finger into the rectum to feel the surface of the prostate for unusual lumps, hard spots, or irregular texture. The US Preventive Services Task Force no longer recommends the DRE as a standalone screening test because there isn’t strong evidence it improves outcomes on its own. Many doctors still use it alongside a PSA test, though, since it can catch abnormalities that blood work alone might miss.
What a DRE Feels Like
You’ll undress from the waist down and be given a gown. Your doctor will ask you to either stand and lean forward over the exam table or lie on your side with your knees pulled toward your chest. The whole thing takes a few minutes. Most people describe it as mildly uncomfortable rather than painful. You may briefly feel like you need to urinate, which is normal and passes quickly once the exam is over.
Understanding Your PSA Results
PSA is measured in nanograms per milliliter of blood. Doctors have traditionally used 4.0 ng/mL as a general cutoff, but what counts as “normal” shifts with age. Research on older men found that the 95th percentile (the upper boundary of normal) was about 4.9 ng/mL for men in their early 60s, rising to roughly 9.0 ng/mL for men in their early 70s and higher still after 80. Your doctor will interpret your number in the context of your age, prostate size, and personal risk factors.
One challenge with PSA testing is its high false-positive rate. A large cohort study found that nearly 47% of elevated PSA results turned out to be false positives, meaning the test flagged a problem that wasn’t actually cancer. The positive predictive value was only about 13%. That means for every 100 men with an elevated reading, roughly 13 actually had prostate cancer. On the flip side, the false-negative rate was low, around 3%, so the test is reasonably good at catching real cases. The tradeoff is that an abnormal result often leads to additional testing, some of which may turn out to be unnecessary.
How to Prepare for a PSA Test
Certain activities can temporarily inflate your PSA and trigger a misleading result. Ejaculation causes a significant spike in PSA levels within the first hour, though levels tend to return to baseline by 24 hours. To be safe, most guidelines suggest avoiding ejaculation for at least 24 to 48 hours before your blood draw. You should also avoid vigorous cycling or anything that puts sustained pressure on the perineal area. If you’ve recently had a urinary catheter, prostate massage, or a prostate biopsy, let your doctor know, as all of these can elevate PSA independently of any disease.
When to Start Screening
The US Preventive Services Task Force recommends that men aged 55 to 69 make an individual decision about PSA screening after discussing the benefits and risks with their doctor. Men 70 and older are generally advised against routine screening because the slow-growing nature of most prostate cancers means treatment is unlikely to extend their life and may cause side effects that reduce quality of life.
These guidelines apply to men at average risk who have no symptoms. If you’re at higher risk, the conversation should start sooner. Black men have the highest prostate cancer rates of any population group in the United States, a disparity linked in part to West African genetic ancestry. Men with a family history of prostate cancer, particularly a father or brother diagnosed before age 65, also face elevated risk. Many major cancer organizations suggest these men begin discussing screening in their 40s.
What Happens After an Abnormal Result
An elevated PSA or a suspicious finding on a DRE doesn’t lead straight to a biopsy the way it used to. The current standard of care is to order a multiparametric MRI of the prostate first. This specialized scan produces detailed images that radiologists score on a 1-to-5 scale called PI-RADS. Scores of 1 and 2 suggest the finding is almost certainly benign. A score of 3 is equivocal. Scores of 4 or 5 indicate a suspicious lesion, and when that lesion measures at least 10 mm, a targeted biopsy is typically the next step.
This MRI-first approach spares many men from unnecessary biopsies. If imaging looks clean, your doctor may recommend monitoring your PSA over time instead of proceeding with an invasive procedure. If a biopsy is needed, the MRI helps guide the needle to the exact area of concern, improving accuracy compared to the older method of taking random samples across the gland.
Symptoms That Should Prompt a Visit
Routine screening is for men without symptoms. But certain changes in urinary function warrant a prostate check regardless of your age or screening schedule. A weak or interrupted urine stream, frequent nighttime urination, and difficulty starting or stopping the flow are common signs of an enlarged prostate, a non-cancerous condition that affects most men as they age.
Some symptoms are more urgent. If you cannot urinate at all, notice blood in your urine, develop a painful and frequent need to urinate alongside fever and chills, or feel significant pain in your lower abdomen, these warrant prompt medical attention. They can indicate infection, acute urinary retention, or other conditions that need treatment quickly.