When should you start getting screened for prostate cancer ? The answer depends on multiple factors, including your age and family history.

Johns Hopkins urologist Christian Pavlovich, M.D., discusses what he wants men to know about today’s prostate cancer screening guidelines.

Prostate Cancer Screening Ages 40 to 54

The PSA test is a blood test that measures how much of a particular protein (called prostate-specific antigen) is in your blood. It’s been the standard for prostate cancer screening for 30 years.

Your doctor will consider many factors before suggesting when to start prostate cancer screening. But he’ll probably start by recommending the PSA test.

While the general guidelines recommend starting at age 55, you may need PSA screening between the ages of 40 and 54 if you:

• Have at least one first-degree relative (such as your father or brother) who has had prostate cancer
• Have at least two extended family members who have had prostate cancer
• Are African-American, an ethnicity that has a higher risk of developing more aggressive cancers

Prostate Cancer Screening Ages 55 to 69

This is the age range where men will benefit the most from screening. That’s because this is the time when:

• Men are most likely to get cancer
• Treatment makes the most sense, meaning when treatment benefits outweigh any potential risk of treatment side effects

Most men will get prostate cancer if they live long enough. Some prostate cancers are more aggressive; others can be slow-growing. Doctors will take your age and other factors into consideration before weighing the risks and benefits of treatment.

You should ask your doctor how often he or she recommends you get screened. For most men, every two to three years is enough.

Depending on the results of your first PSA test, your doctor may recommend you get screened less (or more) frequently.

Decoding a PSA Test

Doctors will consider your age and the size of your prostate when determining what your PSA score means. In general:

• For men in their 40s and 50s: A PSA score greater than 2.5 ng/ml is considered abnormal. The median PSA for this age range is 0.6 to 0.7 ng/ml.
• For men in their 60s: A PSA score greater than 4.0 ng/ml is considered abnormal. The normal range is between 1.0 and 1.5 ng/ml.
• An abnormal rise: A PSA score may also be considered abnormal if it rises a certain amount in a single year. For example, if your score rises more than 0.35 ng/ml in a single year, your doctor may recommend further testing.

An Abnormal PSA Test: What Comes Next?

If your PSA score is in the abnormal range, your doctor may recommend you repeat the PSA test. If your levels are still high, your doctor might recommend one of the newer prostate cancer screening tests available today.

These tests can help better assess your risk for prostate cancer and determine whether a biopsy is necessary. Only a prostate biopsy can definitively diagnose prostate cancer.

For individualized recommendations that suit you, ask your doctor about:

• What age you should start prostate cancer screening
• New blood, urine and imaging tests that are available
• Improved biopsy techniques, if applicable