September is Prostate Cancer Awareness Month, and if you are a man over 55, you have likely heard the advice before: "Just get the test." It sounds simple, but the reality is a little more nuanced. Understanding that nuance is one of the most useful things you can do for your health this month.
Prostate cancer is the most commonly diagnosed cancer among Canadian men, apart from skin cancer, and it is the third-leading cause of cancer death in men. Those numbers are worth taking seriously. But they do not automatically mean that every man should rush out for testing.
The PSA test: helpful, but not the whole story
Most conversations about prostate cancer screening centre on the PSA test, a simple blood test that measures prostate-specific antigen. A higher level can be a sign of prostate cancer, but it can also be caused by non-cancerous conditions, such as an enlarged prostate or a recent infection.
That is the heart of the matter. The PSA test has real benefits, but it also carries real harms, and for many men, the two are more balanced than you might expect. The Canadian Task Force on Preventive Health Care does not recommend routine PSA screening for the general population. Here is the general shape of the guidance:
- Under 55: Screening is not advised.
- Ages 55 to 69: This is the group where the conversation matters most. There is a small potential benefit, but there are also potential harms, so this is a decision to make together with your doctor rather than a box to tick automatically.
- 70 and older: Screening is generally not recommended.
The risks aren't just hypothetical. A "false positive"—where the test indicates a problem that doesn't exist—can result in follow-up biopsies with their own dangers. Overdiagnosis is another concern, as testing might detect a slow-growing cancer unlikely to cause harm during a man's life, yet it still leads to treatment with long-lasting side effects.
What to watch for
Screening is important, but paying attention to your body matters too, regardless of your decision about the PSA test. If you notice anything, talk to your doctor or health care provider:
- Trouble starting to urinate, or a weak stream
- Needing to urinate more often than usual
- Waking up through the night to urinate
These symptoms are common as men age and often have nothing to do with cancer. But they are worth mentioning at your next appointment rather than waiting them out.
Can you lower your risk?
There is no sure way to prevent prostate cancer, and any claim to the contrary would be misleading. However, the habits that promote prostate health are also beneficial for your overall well-being as you age. A sensible approach includes a balanced diet high in fruits, vegetables, and fiber, while limiting red and processed meats. Complement these with regular exercise and maintaining a healthy weight.
The real takeaway: make an informed decision, not a rushed one
If there's a key message from this month, it's that prostate cancer screening isn't just a yes or no choice. It's a personal decision based on factors like your age, family history, overall health, and what you value most. The most effective results come from having an honest discussion with your doctor, supported by reliable information you've had time to consider.
Evidence-based decision aids are created to assist with understanding options, and research indicates they effectively enhance men's knowledge. During this awareness month, consider scheduling that discussion. Come prepared, inquire about both benefits and harms, and select what is best for you.
