There’s no single answer to who should get screened, but experts do have a few recommendations to help you make the best-informed decision for your specific situation.
1. In your 40s
Start talking with your primary care doctor about the benefits and risks of regular screening if you have a family history of prostate cancer. This can raise your risk of developing prostate cancer, and doing so at an earlier age.
Otherwise, ask about a baseline screening, says Stacy Loeb, M.D., assistant professor of urology and population health at NYU Langone Medical Center.
A new study in the Journal of Clinical Oncology found 82 percent of men who died of prostate cancer had a PSA level above the average—0.68 ng/mL—when tested between ages 40 to 49.
Focusing regular screenings on men with a baseline higher than average for their age group—instead of doing PSA tests on everyone—might catch more cases of life-threatening cancer while reducing unnecessary biopsies and treatments, says Dr. Loeb.
2. In your 50s
Even if you don’t have a family history or a high baseline, it’s time to begin discussing regular screenings.
The biggest benefits for PSA tests occur in men 55 to 69, according to the American Urological Association. In large part, that’s because it’s the age when your risk of developing prostate cancer is highest.
You can reduce the risks and preserve most of the upside by getting screened every two to four years instead of every year, the organization notes.
Related: Run Off Prostate Cancer Risk
3. At age 70
Talk with your doctor about whether you still need screenings.
For all but the healthiest men, the risks of screening likely outweigh the benefits at this age. Since most cases grow slowly, you’re more likely to die of something other than prostate cancer, says Dr. Loeb.
4. If you have symptoms
Early prostate cancer has no warning signs.
Symptoms of advanced prostate cancer include pain in the bones of your back, hips, or pelvis; trouble peeing; blood in your urine or semen; and shortness of breath.
See your doctor if you develop them—the benefits and risks of getting PSA tests change once you have signs of the disease. You’re more likely to actually have cancer if you’re taking the PSA test because of symptoms, rather than just for screening.
Plus, the symptoms could also be signs of other serious health problems that require treatment.
Related: 10 Cancer Signs You Shouldn’t Ignore
5. If you’re diagnosed with prostate cancer
Screening means finding cancer in people without symptoms, so once you’re diagnosed, the term no longer applies.
But repeated PSA testing at intervals determined by your doctor could be used to monitor your malignancy to make sure it’s not getting worse, says Men’s Health urology advisor Larry Lipschultz, M.D., professor of urology at Baylor College of Medicine in Houston.
This treatment method is called active surveillance—meaning closely following your cancer, and starting treatment only if it shows signs of getting worse—and it’s a perfectly acceptable treatment option, he says.
In fact, only about one-third of men who choose active surveillance end up needing radiation or surgery, according to the American Cancer Society.
So watchful waiting may be able to save you from unnecessary and potentially harmful treatments that wouldn’t end up helping anyway, while still keeping your disease from advancing.
By Cindy Kuzma