This article originally ran September 19, 2022, and was updated December 3, 2025.
Just as women know to be concerned about breast cancer, men need to be aware of their risk for prostate cancer. Prostate cancer is the most common cancer in men, but many don’t know their risk factors or when to get screened.
We talked to UNC Health urologist Matthew Nielsen, MD, and learned three things men need to know about prostate cancer.
1. Prostate cancer is common, especially in Black men.
Prostate cancer occurs when there is an abnormal growth of cells that originated in the prostate gland, located just below the bladder and in front of the rectum. If the cancer is in a later stage, this growth of abnormal cells can spread to other parts of the body.
“The risk of prostate cancer in a man’s lifetime in the United States is 1 out of 8,” Dr. Nielsen says. “Men with a greater risk than that are men who have male blood relatives who have had prostate cancer and Black men, even those who did not have relatives with prostate cancer. The risk of prostate cancer diagnosis in the lifetime of a Black man is 1 in 6, and Black men’s risk of dying from prostate cancer is twice that of white men.”
This is why Black men and men with a family history of prostate cancer should consider beginning prostate cancer screening between the ages of 40 and 45, while men of other races with low to moderate risk can begin at age 50.
2. Improved screening options for prostate cancer are available.
Prostate cancer is usually slow-growing and has no symptoms unless it’s very advanced.
Men can be screened for prostate cancer with a PSA (prostate-specific antigen) blood test, which can be done at a primary care provider’s office.
“PSA is a protein made by the prostate. The PSA test measures the amount of this protein in the blood,” Dr. Nielsen says. “There are many things that could cause the PSA level to be higher, such as age, an enlarged prostate or a UTI, but if a man has an elevated PSA, it could be a very, very early signal of prostate cancer.”
Sometimes doctors repeat the blood test because false positives can happen. If PSA levels remain high, you’ll be referred to a urologist, a medical specialist of the urinary tract and the male reproductive tract.
A urologist will go over your medical and family history and decide whether to pursue further testing, Dr. Nielsen says.
Digital rectal exams are no longer routinely used to screen for prostate cancer. Newer tests are more accurate and easier for patients. One of the most helpful tools is a prostate MRI, a scan that can show if any areas look suspicious. This test can help many men avoid biopsy.
“Based on MRI findings, about 1 in 3 men can safely avoid a biopsy altogether,” Dr. Nielsen says. “And for men who do need a biopsy, MRI helps us focus on the exact area of concern, making testing more precise.”
3. Even if prostate cancer is detected, your doctor may not recommend immediate treatment.
The overwhelming majority of men who are diagnosed with prostate cancer through a PSA test have cancer that is in the prostate only, meaning it has not spread, Dr. Nielsen says.
Treatment options include surgery to remove the prostate gland completely or various forms of radiation therapy.
“Both options are very effective for prostate cancer,” Dr. Nielsen says. “However, for a relatively large number of men who are diagnosed with prostate cancer through the PSA tests, the likelihood of that cancer causing harm in their lifetime is really low.”
For these patients, the best option may be active surveillance, a care strategy where a cancer is monitored carefully to delay or avoid treatment in people who don’t need treatment right away.
“With active surveillance, we are taking a man who has a very treatable, potentially curable type of prostate cancer and holding off on the risks and potential side effects of treatment because our research has taught us that with the information we can get from the biopsy and other tests, most men with that type of cancer can be followed for years without ever having any progression of their disease,” Dr. Nielsen says. “Active surveillance is not doing nothing. It’s really careful, continued reassessment of the risk of the cancer in that individual patient over time.”
For some men who do need treatment but want to minimize side effects, focal therapy is an emerging option. Focal therapy targets only the area of the prostate containing cancer rather than removing or radiating the entire gland.
“This approach is being studied for select patients and can reduce side effects,” Dr. Nielsen says. “It’s part of a growing movement toward more individualized prostate cancer care.”
Most men determined to be candidates for active surveillance or focal therapy can continue with these strategies safely for years, while a fraction may later need surgery or radiation.
“With the early detection of prostate cancer with PSA screening, we have a six-to-seven-year jump on finding it,” Dr. Nielsen says, “so the window to gather information and make a decision while keeping a patient out of harm’s way is a wide one.”
If you’re concerned about your cancer risk, talk to your doctor. If you do not have a doctor, find one near you.