When doctors talk about PSA screening, a blood test that measures prostate-specific antigen levels to help detect prostate cancer early. Also known as prostate-specific antigen test, it’s one of the most common tools used to screen for prostate issues—but it’s not a diagnosis, and it’s not for everyone. This test doesn’t tell you if you have cancer. It just tells you if your PSA levels are higher than normal, which could mean cancer, an enlarged prostate, an infection, or even just riding a bike the day before.
Prostate-specific antigen, or PSA, a protein made by the prostate gland that leaks into the bloodstream, is naturally present in small amounts. But when levels rise, it raises a red flag. Men over 50, or those with a family history of prostate cancer or African ancestry, are often advised to consider screening. But here’s the catch: not every elevated PSA means cancer, and not every cancer needs immediate treatment. Some tumors grow so slowly they’ll never cause harm. That’s why doctors now talk about shared decision-making, a process where you and your doctor weigh the risks and benefits of testing based on your personal health, age, and preferences instead of just pushing for the test.
What you get back from a PSA test is just a number—but that number doesn’t tell the whole story. Doctors look at trends over time, not just one result. A slow climb might mean something different than a sudden spike. They also check your free PSA, the portion of PSA not bound to proteins, which helps distinguish between benign conditions and cancer. If your total PSA is high but your free PSA is also high, you’re less likely to have cancer. If it’s low, the risk goes up. That’s why some men get a second test before jumping to a biopsy.
And then there’s the bigger question: does finding prostate cancer early actually save lives? Studies show it can, but it also leads to overdiagnosis—treating cancers that would never have caused symptoms. That’s why guidelines have changed. The U.S. Preventive Services Task Force now says men between 55 and 69 should talk to their doctor before deciding. Men over 70, unless they’re in great health, usually don’t benefit from routine screening.
What you’ll find in the posts below isn’t just a list of tests or definitions. It’s real talk about what happens after a high PSA result, how other conditions like infections or medications can mess with the numbers, and what alternatives exist if you’re unsure about testing. You’ll see how men navigate the uncertainty, what doctors actually recommend when the numbers are borderline, and how some people choose to skip screening altogether—without regret. This isn’t about pushing you one way or another. It’s about giving you the facts so you can decide what’s right for your body, your risk, and your peace of mind.
PSA screening for prostate cancer saves some lives but harms many more through overdiagnosis and overtreatment. Shared decision-making between patient and doctor is now the only ethical way to navigate this controversy.