Prostate Health: Screening and Monitoring After Age 50

Prostate cancer is the most commonly diagnosed cancer in men in Canada. In 2024, it was estimated that over 25,000 new cases would be identified in the country (Canadian Cancer Society, 2024). The good news is that when detected early, it is treated in the vast majority of cases with excellent results. The bad news is that like many male cancers, it is often managed late because men consult less and talk less about their health.

Prostate cancer screening is a nuanced subject, with benefits and limitations that deserve to be understood before making an informed decision.

What the prostate is and how it changes with age

The prostate is a walnut-sized gland located below the bladder, surrounding the urethra. It produces part of the seminal fluid. With age, the prostate naturally enlarges, a condition called benign prostatic hyperplasia, or BPH. This benign enlargement can compress the urethra and cause urinary symptoms: a weak stream, frequent urination, urinary urgency, and a feeling of incomplete bladder emptying. These symptoms are common after age 50 and do not necessarily indicate the presence of cancer.

Prostate cancer develops in the glandular cells of the prostate and can coexist with BPH. Its progression is often slow, but some forms are aggressive and require prompt intervention.

PSA testing: what it measures and its limitations

The prostate-specific antigen, or PSA, is a protein produced by prostate cells and measurable in the blood through a simple blood draw. A high PSA level can indicate prostate cancer, but also BPH, prostatitis, or a simple inflammation. Conversely, a normal PSA does not completely rule out cancer.

This is why PSA screening is a decision to be made with the doctor, weighing the benefits of early detection against the risks of over-diagnosis and over-treatment of cancers that would never have caused symptoms. This decision depends on age, family history, ethnicity, and individual preferences.

Screening recommendations in Canada

The Canadian Urological Association recommends a discussion about PSA screening starting at age 50 for men at average risk, and as early as age 40 for those with a first-degree family history of prostate cancer or of African descent, who have a higher risk. This discussion should be informed and shared: the physician presents the benefits and limitations of the test, and the decision rests with the patient.

If the PSA is within normal and stable values, monitoring every two to four years, depending on the level, may be sufficient. An elevation in PSA or a rapid change over time is generally more significant than a single elevated value.

Symptoms to watch for

The urinary symptoms described above warrant medical evaluation even in the absence of formal screening. Bone pain, unexplained weight loss, or blood in the urine or semen are signs that require immediate consultation. These symptoms may indicate cancer at a more advanced stage and call for urgent evaluation.

Frequently Asked Questions about Prostate Health

Does benign prostatic hyperplasia increase the risk of cancer?
No, BPH itself is not a risk factor for prostate cancer. The two conditions can coexist, but one does not cause the other.

Is a digital rectal exam always necessary to evaluate the prostate?
Digital rectal examination allows palpation of the prostate and detection of abnormalities in texture or volume. It is complementary to PSA and can detect certain cancers even with a normal PSA. Its use depends on the clinical context and patient preferences.

Are there modifiable risk factors for prostate cancer?
A diet rich in animal fats and low in vegetables, being overweight, and a lack of physical activity are associated with a higher risk. These factors are modifiable and benefit overall health regardless of prostate risk.

When to consult a healthcare professional

If you are 50 or older and have never discussed prostate cancer screening with a doctor, if you have urinary symptoms that affect your quality of life, or if you have a family history of prostate cancer, you should consult a doctor.

A doctor can discuss screening options with you, prescribe a PSA test if appropriate, and refer you to a urologist if needed. An in-person or remote consultation teleconsultation at one of our Omicron Clinic In Quebec, it allows you to access it without a waiting list.

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