ABSTRACT

Screening for prostate cancer allows the disease to be detected in its early stages, before symptoms appear. In this article, I discuss in detail who should undergo prostate cancer screening and how it should be performed, based on scientific data, current guidelines, and my clinical experience.

Could you have prostate cancer even if you have no symptoms?

This question worries many men because prostate cancer often progresses silently. In this article, as Prof. Dr. Volkan İzol, I will explain the screening process for prostate cancer—including who should be screened and which tests should be performed and when—in simple yet scientifically accurate language.

What Is Prostate Cancer?

Prostate cancer is a type of cancer that develops in the prostate gland and is one of the most common types of cancer in men.

The most important characteristic of this disease is:

  • The ability to move slowly
  • The fact that it doesn't show any symptoms for a long time
  • It is highly treatable when detected early

👉 Clinical fact:
Prostate cancer often starts “silently.” That’s why screening is vital.

What Causes Prostate Cancer?

Although the exact cause of prostate cancer is unknown, certain risk factors have been identified.

🔹 The most important risk factors:

  • Advanced age (the strongest factor)
  • Family history (father/sibling)
  • Genetic mutations (BRCA1/2)
  • Obesity
  • Sedentary lifestyle
  • High-fat diet

👉 Clinical note:
The risk of prostate cancer is significantly higher in individuals with a family history of the disease, and screening should begin earlier.

What Are the Symptoms?

Prostate cancer usually does not cause symptoms in its early stages.

In advanced stages:

  • Difficulty urinating
  • Frequent urination
  • Nocturia
  • Blood in the urine or semen
  • Bone pain

👉 Important message:
Waiting for symptoms to appear means missing the opportunity for early diagnosis.

 

What Is Prostate Cancer Screening and How Is It Done?

Screening for prostate cancer aims to detect the disease in its early stages before symptoms appear.

🔹 Screening tools:

  1. PSA Test

PSA Test

  • It is measured in the blood
  • It is the most commonly used screening method

👉 Important: Elevated PSA levels do not always indicate cancer.

  1. Digital Rectal Examination
  • The firmness and irregularity of the prostate are assessed
  • It is a quick and important clinical test
  1. Multiparametric MRI (mpMRI)

Multiparametric MRI

  • It identifies suspicious areas with high accuracy
  • Reduces unnecessary biopsies
  1. Prostate Biopsy

Prostate Biopsy

  • It is a definitive diagnostic method
  • Performing the procedure under MRI guidance improves accuracy

 

 

 

Who Should Undergo Screening for Prostate Cancer?

Prostate cancer screening is not performed the same way for everyone.

🔹 Groups for whom screening is recommended:

  • Men aged 50 and older
  • High-risk individuals aged 45 and older
  • People with a family history of prostate cancer
  • People at genetic risk

👉 Clinical approach:
Screening should be tailored to the individual. “One-size-fits-all” testing is not the right approach.

How Is the Diagnosis Made?

In cases where the screening results are suspicious, further evaluation is conducted.

🔹 Diagnostic process:

  1. Elevated PSA
  2. mpMRI evaluation
  3. Targeted biopsy

👉 Current approach:
The “MRI → targeted biopsy” algorithm improves diagnostic accuracy.

Which Patients Should Be Treated?

Not all prostate cancers are treated.

🔹 Those who need treatment:

  • Moderate- and high-risk tumors
  • Patients showing clinical improvement

🔹 Patients who can be monitored:

  • Low-risk cancers
  • Elderly patients

👉 This approach:
is important for “preventing overtreatment.”

🟪 My Approach in Clinical Practice

In my clinical practice, as Prof. Dr. Volkan İzol, I tailor the screening process for prostate cancer to each individual.

In particular:

  • In young patients
  • In those with a family history
  • In individuals with fluctuating PSA levels

I'll use a more careful algorithm.

👉 My approach:

  1. PSA Trend Analysis
  2. Risk stratification using mpMRI
  3. Targeted biopsy

In my clinical practice, I have observed that mpMRI-guided biopsies, in particular, reduce unnecessary procedures and improve early diagnosis.

When choosing a treatment:

  • Tumor aggressiveness
  • The patient's age
  • Life expectancy

is in the foreground.

IMPORTANT MESSAGES

  • Prostate cancer is asymptomatic in its early stages
  • Screening saves lives
  • PSA alone is not sufficient
  • mpMRI has revolutionized diagnosis
  • Not all cancers are treated; some are monitored

CONCLUSION + CTA

Screening for prostate cancer is the most critical step toward early diagnosis and successful treatment.

As Prof. Dr. Volkan İzol, my recommendation is that men—especially those in high-risk groups—undergo regular screenings.

Early diagnosis determines both life expectancy and quality of life.

For a detailed evaluation and a personalized screening plan, please contact Prof. Dr. Volkan İzol.

🔥Frequently Asked Questions

❓ When should prostate cancer screening begin?

Prostate cancer screening is generally recommended starting at age 50. However, for men with a family history of prostate cancer, screening should begin at age 45.

❓ At what PSA level is a biopsy necessary?

The PSA level alone does not determine the course of action. The decision to perform a biopsy is made by evaluating the PSA level, the rate of increase, and mpMRI findings together.

❓ Does a high PSA level always mean cancer?

No. Elevated PSA levels can also be caused by an infection, an enlarged prostate, or prostatitis.

❓ Is prostate cancer screening painful?

No. The PSA test is a simple blood test. The procedure is quick and usually painless.

❓Why is mpMRI important?

mpMRI identifies suspicious areas with high accuracy and reduces the number of unnecessary biopsies.

❓ Should all prostate cancers be treated?

No. Some low-risk prostate cancers can be managed with active surveillance.