You’ve probably heard over and over that screenings are key for catching health problems early. When it comes to prostate cancer, especially for Black men, early screening gets a lot of attention. But here’s something you might not know: screenings by themselves might not be enough to catch prostate cancer early. “I would say that I do not believe in ‘screening’ of prostate cancer. I do believe very strongly in early detection,” revealed Dr. Fleming of Virginia Oncology Associates in an interview with BlackDoctor. “Because early detection saves lives.”
Prostate cancer is a major health concern for Black men. While any man can get prostate cancer, Black men are at a much higher risk—not just of being diagnosed, but also of dying from it. That’s why it’s so important to talk openly about prostate health, know your risk factors, and understand why early detection matters.
Here’s the tricky part: prostate cancer usually doesn’t cause any obvious symptoms at first. You can feel completely fine and still have it. By the time you notice things like trouble urinating, blood in your urine, or ongoing pelvic pain, the cancer might already be further along.
That’s why it’s important to know the difference between just getting a routine screening and taking a more complete approach to early detection. Instead of depending on one test, you should talk with your doctor about your personal risk factors and what steps make the most sense for you when it comes to keeping your prostate healthy.
At first read, this may sound a little confusing. Wouldn’t screenings be a part of early detection? Screenings are a good thing, right? Dr. Fleming explains, “Screening implies that you take a random population of patients and you do some testing and you attempt to diagnose a disease with the hope of starting treatment earlier. Early detection really is more appropriate when you have an informed patient and informed physician who looks at what are the optimal treatment strategies for prostate cancer.”
Dr. Fleming is really talking about making prostate cancer care more personal. A screening test might flag a possible problem, but it doesn’t tell you everything about your prostate health.
Early detection means looking at more than just your test results. Your age, family history, medical background, personal risk factors, and even your own preferences all play a part in deciding if you need more testing or a closer look.
This is especially important for Black men, since the risk is higher than for many other groups. A one-size-fits-all approach just doesn’t work here.
When you take an informed approach, you also know what to expect if your test results aren’t normal. For example, a higher PSA level doesn’t always mean you have prostate cancer. Your doctor might need to do more tests to figure out what’s really going on and if you need any more follow-up.
Prostate cancer disparities among Black men are well documented. Black men are more likely to develop prostate cancer, often at younger ages, and are approximately twice as likely to die from the disease compared with White men.
Researchers are still looking into why these differences exist. It could be genetics, family history, access to healthcare, money issues, or even differences in how and when people get treated.
Family history is another important consideration. Having a father, brother, or other close relative diagnosed with prostate cancer can increase a man’s risk, particularly when the relative was diagnosed at a younger age.
Because of these risks, it’s important for Black men to start talking about prostate health sooner rather than waiting for symptoms. Knowing your family history and having honest conversations with your doctor can help you figure out when to start testing and how often you should check in.
You might see churches, barbershops, or health fairs offering free PSA tests—these are blood tests that check for a protein made by your prostate. Higher PSA levels can be a sign of prostate cancer.
The PSA test is one of the main ways doctors look for early signs of prostate cancer. It measures how much prostate-specific antigen is in your blood—a protein made by both healthy and cancerous prostate cells.
But just because your PSA is high doesn’t mean you have cancer. Other things—like an enlarged prostate, inflammation, or even a urinary tract infection—can also raise your PSA levels.
That’s why a high PSA result isn’t an automatic cancer diagnosis. Depending on your situation, your doctor might want to repeat the test, look at your other health issues, or do more exams before deciding what’s next.
The PSA test is a good place to start, but it’s not perfect. Some men with prostate cancer don’t have high PSA levels, and some men have high PSA for reasons that have nothing to do with cancer.
Knowing these limits is why Dr. Fleming says you shouldn’t rely on the PSA test alone. It’s better to look at the whole picture when it comes to your prostate health.
Group screenings don’t always take your family history or current health into account, and that’s where they can fall short. Dr. Fleming believes that just doing random screenings isn’t enough. He says you need three things together: the PSA test, a digital rectal exam, and patient education. Doing only one or two isn’t enough for true early detection.
When you take a personalized approach, you get to understand your own risk and make choices that fit your health. For example, if you’re a Black man with a father or brother who had prostate cancer, your risk is different from someone without that family history.
Your medical history matters, too. Things like past prostate issues, earlier PSA results, medications, and other health problems all affect how your doctor looks at your test results and what they suggest you do next.
Another key part of personalized care is making decisions together with your doctor. You should be able to talk about the pros and cons of prostate cancer testing, including the chance of false alarms, extra tests, or finding slow-growing cancers that might never cause you problems.
If you’re a Black man, make sure these conversations include your higher risk, instead of just following advice meant for people at average risk.
You can think of these three as your winning team.
Dr. Fleming says that catching prostate cancer early means using three key tools: PSA testing, a digital rectal exam, and patient education. Each one helps you understand and keep track of your prostate health in a different way.
The PSA blood test checks your prostate-specific antigen levels and can help spot possible signs of prostate problems, including cancer.
Even though the test is helpful, your PSA levels need to be looked at in context. Your doctor will think about your age, past PSA results, family history, and other health issues when looking at your numbers.
Talking with your doctor about PSA testing on a regular basis can help set a baseline, so it’s easier to notice any changes over time.
A digital rectal exam (DRE) is when a doctor uses a gloved finger to feel the prostate gland and check whether it is smooth. Just the thought of this is enough to keep men from having this procedure performed; Dr. Fleming describes it as “uncomfortable” rather than painful. For those men who look to get out of having a rectal exam, Dr. Fleming likens its necessity to women getting mammograms for breast cancer. “A mammogram isn’t comfortable, but if you’re interested in early detection and trying to take control of your health, then a digital rectal exam and a PSA are appropriate for the early detection of prostate cancer. It’s really the only way to optimize the early detection of prostate cancer.”
During a DRE, your doctor will use a lubricated, gloved finger to feel your prostate, which is right in front of your rectum. This quick check lets them feel for anything unusual, like lumps or firmness.
It’s normal to feel a little embarrassed or uncomfortable about this exam, but it’s usually over quickly. If you’re nervous, ask your doctor to walk you through each step before you start.
When it comes to checking your prostate health, you’ll hear about two main tests: the PSA test and the DRE. The PSA test looks for a specific substance in your blood, while the DRE is when your doctor physically checks your prostate. It’s important to know that neither test alone can catch every case of prostate cancer.
Even if your DRE comes back normal, that doesn’t mean you’re in the clear. Your doctor will look at your exam results, your PSA numbers, your medical history, and anything else that might be important before deciding if you need more tests.
Education refers not only to doctors educating patients about prostate cancer and their options, but also to doctors being more educated themselves. “The American Urological Association does not provide really good guidance in terms of Black Americans. Just the fact that we’re Black Americans, we’re at higher risk. We’re not at, quote, ‘average’ risk. And so their guidelines do not address African Americans whatsoever.”
Learning about prostate cancer is key, especially since a lot of men aren’t sure when to start talking about testing or what their personal risk really is.
If you’re a Black man, having these conversations early matters even more. Prostate cancer can show up sooner and be more aggressive, so waiting for symptoms could mean missing your chance to catch it early.
You should know about your risk factors, your family history, what the PSA test can and can’t do, and what happens if something unusual shows up in your results.
Doctors need to understand that prostate cancer risk isn’t the same for everyone. When they know the facts, they can give better advice and make sure Black men get the care and follow-up they deserve.
When you know your options, you can ask the right questions, take part in decisions about your health, and speak up for yourself.
Your age matters when it comes to deciding when to start talking about prostate cancer screening.
Dr. Fleming recommends that Black men begin early detection efforts between ages 40 and 45. This reflects the importance of recognizing their increased risk and not automatically treating them as average-risk patients.
Current medical recommendations also recognize that Black men may benefit from discussing prostate cancer screening earlier than men at average risk. The American Cancer Society recommends that Black men discuss screening with their healthcare providers beginning at age 45, while men with particularly strong family histories may need to begin discussions even earlier.
The best time to start and how often you should get tested is something you and your doctor can figure out together after talking it through.
Don’t wait until you’re 50 or until you notice symptoms to bring up prostate health. Starting the conversation earlier helps you understand your risk and make a plan that fits you.
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