Most men who should be talking to their doctors about prostate cancer screening are not doing so, according to a report by U.S. News and World Report, and the gap is raising concerns among health professionals who say early detection depends on those conversations happening.
Prostate cancer is one of the most common cancers among men in the United States. Screening typically involves a blood test that measures prostate-specific antigen, or PSA, levels. Elevated PSA can indicate the presence of cancer, though it can also reflect other conditions. Because the test carries both potential benefits and risks, major medical guidelines recommend that men discuss screening with their doctor before deciding whether to get tested.
That discussion is not happening for the majority of eligible men. The report found that rates of formal shared decision-making conversations between patients and physicians about prostate cancer screening remain very low. Men often either skip screening entirely or get tested without any prior conversation about what the results could mean and what follow-up steps might involve.
The reasons behind the gap are multiple. Some men avoid the topic because they have no symptoms and do not feel at risk. Others say they were never prompted by a doctor to bring it up. Primary care visits are often short, and preventive screenings that require extended explanation can get pushed aside when other health issues take priority during an appointment.
Age and family history are among the most important factors in determining who should consider screening. Men with a first-degree relative who had prostate cancer, and Black men, face higher risk and are generally advised to begin screening conversations earlier, sometimes as young as 40. The report noted that these higher-risk groups are not consistently receiving targeted outreach to start those discussions.
The consequences of missed conversations can run in both directions. Some prostate cancers are slow-growing and may never require treatment, meaning unnecessary screening can lead to interventions that cause more harm than the cancer itself. Other cases are aggressive and benefit significantly from early detection. The decision about whether to screen requires weighing those trade-offs, which is exactly what the shared decision-making conversation is meant to support.
Health advocates say the burden should not fall entirely on patients to raise the subject. Clinicians play a central role in creating the opening for these discussions, particularly during routine annual visits when the opportunity is clearest.
