A prostate cancer diagnosis—or even the possibility of one—can bring up many questions. In the exam room, I often hear the same concerns from men and their families: How serious is it? Will I have symptoms? Does an elevated PSA mean I have cancer? What happens if cancer is found?

These are important questions. Having clear, reliable information can make prostate cancer screening and the diagnostic process feel less overwhelming. Here are answers to some of the questions urologists hear most often.

Does an elevated PSA mean I have prostate cancer?

No. An elevated PSA does not automatically mean that you have prostate cancer.

PSA, or prostate-specific antigen, is a protein produced by cells in the prostate. A higher-than-expected PSA level can be associated with prostate cancer, but it may also be caused by benign prostatic hyperplasia (BPH), inflammation, infection, recent prostate stimulation, or other factors.

That is why prostate cancer is not diagnosed based on a PSA result alone. Your urologist will consider your PSA level along with your age, previous PSA results, family history, digital rectal exam findings, and other personal risk factors. Depending on the situation, additional testing may be recommended.

The important point is that an abnormal PSA is a reason for further evaluation—not a prostate cancer diagnosis.

Can you have prostate cancer without symptoms?

Yes. This is one of the most important things men should understand about prostate cancer.

Early-stage prostate cancer often causes no noticeable symptoms. A man may feel completely well and still have prostate cancer. This is one reason conversations about screening are important, particularly for men who may be at increased risk.

When urinary symptoms occur—such as a weak urine stream, difficulty starting urination, frequent urination, or getting up repeatedly at night—they are often caused by benign prostate enlargement rather than cancer. However, new or persistent urinary changes should still be discussed with a urologist.

Who is at greater risk for prostate cancer?

Prostate cancer can affect any man, but certain factors may increase the risk. These include:

• Increasing age
• Being of African American descent
• Having a father or brother who was diagnosed with prostate cancer
• Having multiple relatives affected by prostate cancer
• Having a relative diagnosed at a younger age
• Carrying certain inherited genetic changes, including some BRCA1 or BRCA2 mutations
• Having a family history of breast, ovarian, pancreatic, or certain other cancers

Understanding your personal and family history can help your physician determine when a conversation about prostate cancer screening should begin.

If prostate cancer is found, does it always need to be treated?

Not necessarily. Prostate cancer can behave very differently from one patient to another.

Some prostate cancers grow so slowly that they are unlikely to cause problems during a man’s lifetime. For appropriate patients with low-risk disease, active surveillance may be recommended instead of immediate treatment.

Active surveillance does not mean ignoring the cancer. It involves carefully monitoring it through PSA testing, prostate imaging, periodic biopsies, and other testing as appropriate. If there are signs that the cancer is changing or becoming more aggressive, treatment can then be considered.

Other prostate cancers are more aggressive and require treatment. The goal is to understand the individual cancer well enough to select an approach that provides effective cancer control while also considering the patient’s overall health, preferences, and quality of life.

Is prostate cancer hereditary?

Sometimes. Most prostate cancers are not caused by a clearly inherited genetic change, but prostate cancer can run in families.

Having a father or brother with prostate cancer can increase your risk, particularly if the relative was diagnosed at a younger age or if several close family members have been affected.

Certain inherited genetic changes can also increase the likelihood of developing prostate cancer or a more aggressive form of the disease. A family history of breast, ovarian, pancreatic, or other cancers may provide important information as well.

Men should know their family’s cancer history—not only its history of prostate cancer—and share that information with their physician. In some situations, genetic counseling or testing may be appropriate.

What happens if my doctor finds something concerning?

The next step will depend on what raised the concern. Your urologist may recommend repeating the PSA test, performing additional blood or urine biomarker testing, conducting a digital rectal exam, obtaining a prostate MRI, or performing a prostate biopsy.

Today’s diagnostic tools provide physicians with more information than was available in the past. Prostate MRI, biomarker tests, and other risk-assessment tools can help determine which men may be more likely to have clinically significant prostate cancer and whether a biopsy or additional evaluation may be appropriate.

If a biopsy is needed, the results help determine whether cancer is present and, if so, how likely it may be to grow or spread.

Is prostate cancer curable?

When prostate cancer is detected while it is still localized, it is often highly treatable, and many patients have an excellent long-term outlook.

Treatment options may include surgery or radiation therapy. The appropriate recommendation depends on several factors, including the cancer’s stage, Grade Group or Gleason score, PSA level, the patient’s overall health, and personal treatment preferences.

Even when prostate cancer has spread beyond the prostate, treatment has advanced significantly. Hormone therapy, targeted therapy, immunotherapy, chemotherapy, radiopharmaceuticals, and other treatments may help control the disease. The specific approach is personalized based on the characteristics of the cancer and the individual patient.

What can I do to protect myself?

There is no guaranteed way to prevent prostate cancer. However, you can take an active role in your prostate health by understanding your personal risk and discussing screening with your physician.

Know your family’s cancer history, keep up with routine medical care, and do not wait for symptoms before asking about prostate cancer screening. Your physician can help you weigh the potential benefits and limitations of PSA testing based on your age, overall health, family history, and other risk factors.

For many men, the most important first step is simply starting the conversation.

Have questions about your prostate cancer risk or PSA level? Schedule an appointment with an AUCNY urologist to discuss whether screening or further evaluation is appropriate for you.