Prostate Cancer Screening
Understanding your risk
Attention all men!
When should you have your first prostate check, and how often should it be repeated?
These are worthwhile questions to discuss with your GP , and the answers depend on your individual risk and circumstances.
As part of caring for my patients at Peak Family Practice, I keep up with developments in South Africa and internationally. Having trained in Australia, I also follow guidance from there with interest, including the newly published 2026 Guidelines for the Early Detection of Prostate Cancer. These offer useful insights to consider alongside South African recommendations, with the focus remaining on what is appropriate for each patient.
Understanding your risk
Your age, family history and ancestry can all influence your risk of prostate cancer.
HIGHER RISK men include:
Men with a family history of prostate cancer: Those with an affected first-degree relative such as father or brother, a relative diagnosed at a younger age, or several affected family members.
Men of sub-Saharan African ancestry.
Men with certain inherited genetic changes, such as a BRCA2 pathogenic variant, which can increase the likelihood of developing prostate cancer.
A family history of breast or ovarian cancer may also be relevant, particularly where an inherited cancer condition is suspected.
USUAL RISK are all other men.
When should testing begin?
HIGHER RISK: From age 45.
USUAL RISK: From age 50.
From age 40, or sometimes earlier, for men with certain inherited cancer-risk gene variants, including BRCA2, depending on their family history.
The frequency of testing should be personalised according to your risk and previous PSA results. A two-yearly test may be appropriate for some men, while others need a different follow-up schedule.
Around age 70, it is important to review whether continued screening is likely to benefit you. Your overall health, other medical conditions, life expectancy and preferences should all form part of that discussion.
What does a PSA test tell us?
The prostate-specific antigen, or PSA, test is a blood test that measures a protein produced by the prostate.
An elevated PSA does not necessarily mean that you have prostate cancer. Non-cancerous conditions, including benign prostate enlargement and inflammation, can also raise the level. Equally, a result within the expected range does not completely rule out cancer. The result therefore needs to be interpreted in the context of your age, risk factors and clinical assessment.
If your PSA is mildly elevated, a repeat test may be recommended, often within one to three months, to establish whether the elevation persists. The timing and need for further investigation depend on the result and your circumstances. A persistently elevated PSA or other concerning findings may lead to referral to a urologist. An MRI scan may form part of the assessment, with a biopsy considered according to the findings and your overall risk.
Preparing for your PSA test
To help avoid a temporarily raised PSA result, avoid ejaculation, cycling and strenuous exercise for 48 hours before your blood test. You do not need to fast for a PSA test alone, although this may be necessary if you are having other blood tests at the same time.
Let your doctor know about any recent urinary infection, prostate inflammation, catheter or procedure involving your bladder or prostate, as well as any medicines you take. These can affect your PSA result, and in some circumstances it may be better to delay the test. Your doctor will advise you on the appropriate timing.
You are still welcome to attend your consultation if you have not followed the preparation advice. We can discuss your prostate health and arrange the blood test for a suitable time.
Making an informed decision
The aim of screening is to identify prostate cancers that are likely to affect your health or lifespan, while reducing unnecessary investigations and treatment.
Before arranging a PSA test, I will discuss its potential benefits, limitations, possible next steps and costs with you. Together, we can decide whether testing is appropriate and agree on a follow-up plan.
To discuss your prostate health or find out whether screening is appropriate for you, book a consultation with me, Dr Andrew Lane, at Peak Family Practice.
Where appropriate, your blood sample can be taken here at the practice immediately after your consultation, saving you a separate visit to a pathology collection centre.
