Clinical content reviewed: August 7, 2026
Prostate cancer can develop without causing symptoms in its early stages. Screening means testing for possible cancer before symptoms appear. The goal is to find clinically significant cancer early while avoiding unnecessary tests and treatment for cancers that would never cause harm.
Canadian recommendations: a personalized decision
Canadian recommendations are not all the same:
- The Canadian Task Force on Preventive Health Care (2014) recommends against routine PSA screening. Its recommendation is strong for people younger than 55 and those 70 or older, and weak for people aged 55–69. The Task Force emphasizes that the possible reduction in prostate-cancer deaths is small and must be weighed against false-positive results, overdiagnosis, and treatment-related harms.
- The Canadian Urological Association (2022) suggests offering PSA screening to people with a life expectancy of more than 10 years after the benefits and possible harms have been discussed. The final choice should be made through shared decision-making.
At Bina Medical Clinic, we encourage a personalized discussion based on your age, health, family history, ancestry, personal values, and preferences. Screening is a choice—not an automatic test for everyone.
What is the PSA test?
Prostate-specific antigen (PSA) is a protein produced by prostate cells. A PSA test measures its level in a blood sample.
A higher PSA level does not necessarily mean cancer. PSA may also rise because of benign prostate enlargement, inflammation, infection, or other factors. Some people with prostate cancer do not have a high PSA. The PSA test therefore cannot diagnose cancer by itself. A digital rectal examination (DRE) may also be considered as part of the assessment.
When should you discuss screening?
If you have no symptoms and choose screening after an informed discussion, the Canadian Urological Association suggests:
- Average risk: consider starting PSA testing at age 50.
- Higher risk: consider starting at age 45. Higher-risk groups include Black people, including those of African or Caribbean ancestry, and people with a family history of prostate cancer.
- Known inherited risk: people with a cancer-associated genetic variant such as BRCA1, BRCA2, or HOXB13 need an individualized plan, often with genetic or specialist advice.
- Stopping screening: screening is generally stopped at age 70 or when life expectancy is less than 10 years. Stopping may be considered at age 60 when PSA is below 1 ng/mL. Exceptionally healthy people over 70 may still choose testing after discussing the limited evidence and their preferences.
Screening before age 45 is generally not recommended unless there is a specific inherited or unusually high risk.
Possible benefits
- Finding an aggressive cancer before it causes symptoms or spreads
- Creating an opportunity for potentially curative treatment
- Possibly reducing the risk of death from prostate cancer in some age groups
Possible limitations and harms
- A false-positive or uncertain result, causing anxiety and repeat testing
- Additional investigations such as imaging or prostate biopsy
- Bleeding, infection, pain, or other complications from biopsy
- Overdiagnosis: finding a slow-growing cancer that would never have caused illness
- Overtreatment: treatment that may cause urinary incontinence, erectile dysfunction, bowel symptoms, or other effects without providing meaningful benefit
An early diagnosis does not always mean immediate treatment. Active surveillance may be appropriate for some low-risk cancers.
How often is PSA testing repeated?
For people who choose screening, the Canadian Urological Association suggests adapting the interval to the previous PSA result:
- PSA below 1 ng/mL: usually every 4 years
- PSA from 1 to 3 ng/mL: usually every 2 years
- PSA above 3 ng/mL: consider a shorter interval or additional assessment
These numbers are guides, not a diagnosis or a universal biopsy threshold. Age, overall health, previous results, prostate examination, medications, family history, ancestry, and personal preferences all matter.
What happens if PSA is elevated?
One elevated result does not mean you have cancer and should not automatically lead to a biopsy. Your clinician may repeat the PSA test, review possible non-cancer causes, perform a prostate examination, use a risk calculator or another blood test, or refer you to a urologist. When the risk remains elevated and treatment would be considered if cancer were found, multiparametric MRI may be recommended before a first biopsy.
Symptoms should be assessed—not screened
Screening is intended for people without symptoms. Contact a healthcare professional promptly if you develop blood in the urine or semen, new or worsening difficulty urinating, persistent unexplained bone pain, or unexplained weight loss. These symptoms are often caused by conditions other than cancer, but they should be assessed without waiting for a screening age.
Talk with us
If you are considering prostate cancer screening, book an appointment with Bina Medical Clinic. We can review your individual risk and help you decide whether PSA testing is right for you.
Official sources
- Canadian Urological Association — 2022 guideline on prostate cancer screening
- Canadian Task Force on Preventive Health Care — Prostate cancer
- Canadian Cancer Society — Finding prostate cancer early
This information is for education only and does not replace medical advice, diagnosis, or treatment from a qualified healthcare professional.
