Prostate cancer screening and treatment: What you need to know
October 20, 2025
Prostate cancer is among the most diagnosed cancers for men – and the risk increases significantly as they get older. Some research suggests as many as half of all men in their 70s and 80s have some evidence of the disease, yet many will never experience symptoms or require treatment. That’s because most prostate cancers grow slowly, do not spread beyond the prostate, and are unlikely to affect a man’s quality of life or lifespan.
But not all prostate cancers are the same. Some are aggressive, growing quickly and spreading beyond the prostate, often to the bones or lymph nodes. These more dangerous forms of prostate cancer can be life-threatening and require prompt treatment.
The announcement in May that former President Joe Biden was diagnosed with aggressive stage four prostate cancer at age 82 prompted renewed discussions about prostate cancer screening practices. A spokesman reported in October that the former president has started radiation and hormone therapy as part of his treatment plan.
Prostate-specific antigen (PSA) blood tests are widely used to screen for prostate cancer, but most health care guidelines don’t recommend them after age 70 (President Biden reportedly had his last screening in 2014). Additionally, PSA levels can be elevated for reasons other than cancer, and not all prostate cancers detected by screening need immediate – or in some cases any – treatment. This means PSA screening can sometimes lead to unnecessary anxiety, additional testing, and even overtreatment for cancers that would never cause harm.
It’s a good time to learn more about PSA screening and prostate cancer – and to talk with your doctor about early diagnosis and potential treatment options.
Who is most at risk for prostate cancer?
Let’s start with the basics. The prostate is a walnut-sized gland that sits below the bladder and in front of the rectum. As part of the male reproductive system, the prostate makes seminal fluid. As men age, the prostate typically gets larger.
It’s unclear what causes prostate cancer to develop, but some men are at higher risk than others. Among the factors that increase the risk are:
- Age: The average age for a prostate cancer diagnosis is 67, according to the American Cancer Society. The disease is rare among men younger than 40.
- Ethnicity: African American men and Caribbean men of African ancestry have a higher risk of developing prostate cancer.
- Family history: The chances of developing prostate cancer are increased among those with relatives, especially a father or brother, who have had the disease.
- Genetic variations: Certain inherited genetic mutations, including those in genes such as BRCA1 or BRCA 2, or among men with Lynch syndrome, can increase the risk.
Related reading: What We Know About Your Prostate
How is prostate cancer diagnosed?
In 1986, the FDA approved the PSA test, which checks a blood sample for a protein produced by cells of the prostate. Elevated PSA levels are often – but not always – an indicator of prostate cancer. The test was initially used to monitor progress of the disease. In 1992, the PSA test was approved as a diagnostic tool.
A single elevated PSA test is not confirmation of prostate cancer.
The PSA test is a screening tool that can detect prostate cancer at an early stage. The blood test may be accompanied by a digital rectal exam (DRE), which allows your doctor to check the prostate for any physical abnormalities.
An elevated PSA level could be a sign of prostate cancer. But it’s not a definitive diagnosis. PSA levels naturally go up as men age. Certain physical activities such as cycling or heavy lifting as well as sexual intercourse prior to testing may also temporarily increase PSA levels. The number may also rise due to infections of the prostate or urinary tract.
One of the most common reasons for a higher PSA level is benign prostatic hyperplasia (BPH), which is essentially an enlarged prostate that occurs as men age. It may come with urinary tract symptoms that can be irritative (urgency to urinate) or obstructive (weak stream or leakage after urination). BPH treatments range from lifestyle changes to medication as well as noninvasive laser treatments or surgery.
To further test for prostate cancer, magnetic resonance imaging (MRI) of the prostate can be performed to look for abnormalities in the prostate gland that are of increased likelihood to represent cancerous tumors. The only way to definitively diagnose prostate cancer is with a biopsy. A tissue sample will be collected from the prostate. A pathologist then analyzes the sample for signs of cancer cells. At UT Southwestern we perform prostate biopsies using transrectal ultrasound and MRI that’s been shown to be more effective than a standard biopsy at detecting high-risk cancer.
What are the screening recommendations for prostate cancer?
Prostate cancer is highly treatable when diagnosed early. But getting screened for it comes with pros and some cons.
Screening may detect slow-growing cancers – the kind that won’t cause harm if left alone. That creates a potentially nerve-wracking scenario in which the patient is living with prostate cancer and waiting five or 10 years or more before needing treatment.
There is also the possibility of undergoing treatment that won’t extend life but could worsen the quality of life. Some treatments lead to erectile dysfunction or incontinence. There is also the potential for unnecessary biopsies, which have risks for complications.
Related reading: Sex after prostate cancer: Treatment choice matters
New center for seamless prostate cancer treatment
A new Center for Prostate Cancer Care is being developed at UT Southwestern to optimize evaluation and treatment for patients. A care navigator will guide patients through the screening process while a multidisciplinary team of specialists will provide the most effective treatment personalized for each patient.
Guidance on when and how often to get screened can create confusion, too. For instance:
- The U.S. Preventative Services Task Force (USPSTF), an independent panel of health experts, recommends that men talk with their physician about screenings between ages 55 and 69. The agency advises against routine PSA screenings past age 70.
- The National Comprehensive Cancer Network (NCCN) recommends screening for men between ages 40 and 75 who are at a higher risk for prostate cancer.
- The American Urological Association (AUA) recommends a baseline PSA test between ages 45 and 50 and testing every two to four years between ages 50 and 69. Those at higher risk may consider screening as early as age 40. The AUA calls for a discussion with your provider about testing beyond age 70 for men in good health.
- The American Cancer Society recommends prostate cancer screening to begin at age 45 for men at high risk and at age 50 for men at average risk. It advises men with a family history of the disease to consider screening starting at age 40.
Bottom line: Discuss PSA testing with your primary care physician or urologist to determine what works best for you.
What are the symptoms of prostate cancer?
Some men experience no symptoms at all. Those who do have issues commonly report:
- More frequent urination, especially at night
- Difficulty initiating the urine stream or slow flow
- Urinary urgency
- Pain when urinating
- Blood in the urine or semen
But having those symptoms may not necessarily mean you have prostate cancer. That’s why it is important to meet with your health care provider to track down the source.
I’ve been diagnosed with prostate cancer. Now what?
Treatment options vary. We use a histologic grading scale, called the Gleason score, that ranks the aggressiveness of prostate cancer. The higher the score, the more likely the cancer has the capacity to spread and metastasize. We also factor in the stage of the cancer – for example, does it involve one or both sides of the prostate, does it appear to extend past the capsule that surrounds the prostate, or does it appear on scans to have spread beyond the prostate to more distant sites in the body – as well as the PSA level when making treatment recommendations. Crucially, we consider the patient’s current health, their age, and their personal preferences when developing a treatment plan.
The more aggressive the cancer, the more quickly treatment should start, especially for patients experiencing symptoms from metastatic cancer.
Standard treatment options for patients with localized prostate cancer that may pose a risk to health and longevity include surgery to remove the prostate (radical prostatectomy) or radiation therapy. Many factors are considered by the patient and their doctor when deciding on a treatment plan. For example, surgery is not for everyone. It’s an invasive procedure that comes with life-altering side effects. In some cases of low-risk prostate cancer, patients can safely postpone surgery or radiation for up to a decade or more if they do appropriate active surveillance to make sure the cancer is not getting worse.
Other forms of local therapy can also be considered. UTSW was among the first centers in the U.S. to offer an advanced outpatient procedure called transurethral ultrasound ablation (TULSA), which uses heat to destroy the cancer. There are no incisions, surgery, or radiation. And research has shown TULSA has fewer side effects than other therapies. Patients with low- to intermediate-stage disease are eligible for the treatment.
With aggressive forms of the disease, hormone therapy is often the first option. The goal is to eliminate and block the hormone testosterone, which can fuel prostate cancer. One of the advantages of hormone therapy is that it targets cancer cells anywhere in the body, not just in the prostate. However, although hormone therapy is a life-prolonging treatment for many patients with prostate cancer, it is not a curative treatment. And it does come with side effects, including hot flashes, weight gain, loss of muscle mass, fatigue, decreased sex drive, and more, that can affect quality of life.
Patients receiving treatment with hormone therapy are counseled to take steps through exercise and a healthy diet to keep their weight under control and optimize their quality of life while receiving treatment.
At the UTSW Harold C. Simmons Comprehensive Cancer Center, we have amassed expertise among providers across multiple disciplines, including medical oncologists, urologists, radiation oncologists, nuclear medicine experts, interventional radiologists, and pathologists, to provide our patients with the most advanced care for prostate cancer.
We also offer clinical trials to try to advance prostate cancer treatments and to identify new therapies or new combinations of therapies. Our goal is to help find the treatment that’s right for you.
To talk with an expert about prostate cancer, make an appointment by calling 214-645-4673 or request an appointment online.
