Prostate cancer is one of the most common cancers affecting men, and it’s a condition that brings understandable concern when it comes to screening, prevention, and treatment. With so much information—and misinformation—out there, it’s important to review the facts about risk, screening, prostate-specific antigen (PSA) testing, and how therapies like testosterone replacement fit into the bigger picture.
How Common Is Prostate Cancer?
Prostate cancer is the second most common cancer in men worldwide, after skin cancer. In the United States:
- About 1 in 8 men will be diagnosed with prostate cancer during their lifetime.
- The risk increases with age, with most cases diagnosed in men over 65.
- African American men and those with a family history of prostate cancer have a significantly higher risk.
While prostate cancer is common, it’s also important to remember that many prostate cancers grow slowly. Some men may live their entire lives with the disease and never need treatment. That said, aggressive forms of prostate cancer do occur, and early detection can be life-saving.
The Role of Screening
PSA Testing and Digital Rectal Exam (DRE)
The two primary tools for prostate cancer screening are:
- Prostate-specific antigen (PSA) blood test – measures the level of PSA, a protein made by the prostate. Higher levels can be associated with prostate cancer, but also with benign conditions like an enlarged prostate (BPH) or prostatitis (inflammation).
- Digital rectal exam (DRE) – allows a physician to feel for irregularities in the prostate.
Why Screening Matters
- Early detection often means prostate cancer can be treated before it spreads.
- Screening can reduce the risk of dying from prostate cancer, particularly in higher-risk men.
- Screening decisions should be individualized, weighing risks and benefits, especially for men between ages 50–70.
The American Urological Association and U.S. Preventive Services Task Force recommend discussing PSA screening with your physician rather than taking a one-size-fits-all approach.
What Happens If You Have an Elevated PSA?
An elevated PSA does not automatically mean you have prostate cancer. In fact, the majority of elevated PSAs are due to non-cancerous conditions. Here’s what usually happens next:
- Repeat Testing – A second PSA test may be recommended to confirm results, since levels can fluctuate.
- Rule Out Other Causes – Things like urinary tract infections, recent ejaculation, prostate inflammation, or even bike riding can temporarily raise PSA.
- Free PSA or PSA Density Testing – These refinements can help better understand whether an elevated PSA is likely due to cancer.
- MRI of the Prostate – Modern imaging can detect suspicious areas with greater accuracy than biopsy alone.
- Biopsy – If concerns remain, a urologist may recommend a prostate biopsy to confirm whether cancer is present.
Understanding Gleason Score
If prostate cancer is diagnosed, the Gleason score helps determine aggressiveness. The score is based on how prostate tissue looks under the microscope:
- 6 or less – usually low-grade, slower-growing.
- 7 – intermediate risk.
- 8–10 – higher grade, more aggressive cancers.
This score helps guide decisions about whether to monitor, treat, or use more aggressive therapies.
Testosterone and Prostate Cancer: Clearing Up the Confusion
One of the most common misconceptions in men’s health is that testosterone replacement therapy (TRT) causes prostate cancer. This belief originated decades ago but has been disproven by modern research.
What the Evidence Shows
- TRT does not cause prostate cancer. Multiple large studies and reviews show no increased risk of developing prostate cancer in men taking TRT compared to men who are not.
- TRT does not worsen the Gleason score. In men who do develop prostate cancer, testosterone therapy does not change the grade or aggressiveness of the disease.
- TRT and PSA monitoring. Testosterone therapy can sometimes raise PSA slightly because it stimulates prostate tissue, but this does not mean cancer is present. Men on TRT simply need regular PSA and prostate monitoring, which is already recommended for age and risk-based screening.
The Important Caveat
If you have an active, untreated prostate cancer, TRT is not recommended. Testosterone can stimulate the growth of existing cancer cells, which is why physicians avoid prescribing it in that setting. However, men with a history of treated prostate cancer (such as surgery or radiation) may be eligible for TRT under careful specialist supervision.
Why Ongoing Monitoring Matters
Whether you’re considering TRT, have risk factors for prostate cancer, or are simply being proactive, regular monitoring is essential:
- PSA blood testing at intervals recommended by your physician.
- Digital rectal exams when indicated.
- Imaging or biopsy if abnormalities are found.
Prostate health isn’t a one-time check—it’s something to track over time. This allows physicians to catch changes early, when interventions are most effective.
Lifestyle and Prostate Cancer Risk
While genetics and age play large roles, lifestyle choices also affect prostate cancer risk and progression:
- Diet – A diet high in vegetables, fiber, and healthy fats may be protective, while excess processed foods and red meats may increase risk.
- Exercise – Regular physical activity is associated with lower risk and better outcomes.
- Weight management – Obesity is linked to more aggressive prostate cancers.
- Avoiding smoking and excess alcohol – Both worsen outcomes across multiple cancers, including prostate.
Key Takeaways
- Prostate cancer is common, but not all cases are life-threatening. Early detection saves lives.
- PSA screening and monitoring should be personalized, especially for higher-risk men.
- An elevated PSA does not always mean cancer—other causes are common, and further testing helps clarify.
- The Gleason score determines how aggressive prostate cancer is and helps guide treatment.
- TRT does not cause prostate cancer or worsen cancer grade, but it should be avoided in men with active, untreated disease.
- Healthy lifestyle choices, regular monitoring, and open conversations with your physician are the best strategies for long-term prostate health.
At Longevity Health Clinic, we always monitor PSA levels closely in men receiving TRT. This ensures safety, early detection of any changes, and peace of mind for our patients.
