Prostate cancer is the most common cancer diagnosed among men in the United States – and some groups of men are at greater risk than others. That’s why the question of when to get screened for prostate cancer depends a lot on who’s getting screened.
Ideas about the “who” and “when” of prostate cancer screening have been evolving as new evidence emerges about disease patterns, relative risk, life expectancy, and more. The emphasis is shifting toward a more personalized approach that takes risk factors into account and relies on shared decision making between the man and his provider.
And if prostate cancer is diagnosed, that patient-provider conversation expands to include whether the cancer is dangerous enough to need immediate treatment, or whether a “watchful waiting” approach with regular scans and tests is best. For a large percentage of men with low-risk, slow-growing prostate cancer, the side effects of surgery or radiation may outweigh the benefits of treatment.
“Prostate cancer screening and detection have certainly changed over the years,” says University of Colorado Anschutz Cancer Center member David Strauss, MD, a urologist who specializes in prostate cancer and an assistant professor in the CU Anschutz Department of Surgery’s Division of Urology.
“It’s not commonly a lethal cancer,” he says. “Screening can detect it early, and when we treat patients, they typically have a good outcome. You want to be able to capture cancers that may be harmful in the future and treat them appropriately. But that said, one of the hot topics with prostate cancer screening is overdiagnosis and overtreatment. So we try to thread the needle.”
‘What’s going on?’
According to the American Cancer Society, about one in every eight men will be diagnosed with prostate cancer during their lifetime. Statewide in Colorado, the annual incidence rate for prostate cancer is 103.3 new cases among 100,000 people, below the national rate of 119.9, based on a five-year average covering 2019-2023. Each year, about 581 people in Colorado die of prostate cancer.
The vast majority of people diagnosed with prostate cancer do not die from it, but because of the sheer volume of cases, it’s the second leading cause of cancer death among men in the United States, behind only lung cancer.
Prostate cancer’s impact is not uniform. For example, the CU Anschutz Cancer Center’s Exploring Cancer in Colorado (ECCO) platform, which creates maps and displays data on cancer in the state, shows that prostate cancer incidence rates are highest in two of Colorado’s mountain counties – Routt (home of Steamboat Springs) and Chaffee (home of Salida and Buena Vista). In those counties, the annual incidence rate is 180.1 per 100,000 for Routt and 158.6 per 100,000 for Chaffee.
In Colorado, incidence rates are also higher than the norm for Black men (162.6 per 100,000). And while prostate cancer is rare among men under age 50, incidence starts increasing dramatically after 50, with the peak age range for new diagnoses between ages 65 and 75. Men with a “first-degree relative” – a father or brother – who had prostate cancer are also at higher risk.
These and other data points inform how Jan Lowery, PhD, MPH, talks about prostate cancer to community members on her many trips around the state. Lowery, an epidemiologist and data scientist, is the cancer center’s assistant director for dissemination and implementation in its Office of Community Outreach and Engagement (COE) and a professor at the Colorado School of Public Health.
Lowery was in Routt County in October 2025 as part of the cancer center’s Research Roadshow series of informational events around the state. She displayed an ECCO map showing the county’s high prostate cancer rates, drawing interest from the Steamboat Pilot & Today newspaper. “We drew maybe 80 to 100 people, and they were saying, ‘What’s going on in our county?’” she recalled.
It’s not clear why the county’s rate is as high as it is, “but recently they’ve had a big influx of people going there to retire, and that’s a high-incidence population,” Lowery says. Also, she notes that “incidence of prostate cancer goes up when you’re looking for it,” suggesting that regional differences in screening rates may partly account for varying incidence rates.
Lowery says she often hears questions about prostate cancer at her stops around the state. “There seems to be some confusion out there in the public about whether they should be screened,” she says.
→ A More Personalized Path for Prostate Cancer Care: Inside the ‘Triple Switch’ Clinical Trial
A walnut-sized gland
In men, the prostate is a walnut-sized gland at the base of the bladder and adjacent to the rectum. It surrounds the urethra, the tube that carries urine from the bladder to the penis. It makes semen fluid that mixes with sperm produced by the testicles, and it contains muscles that help push semen through the urethra during an orgasm.
According to Strauss, the first line of screening for prostate cancer is a test measuring the level of prostate-specific antigen (PSA), a protein produced by the prostate.
A high PSA level does not necessarily mean a man has cancer, because it can also be a sign of another problem, such as an enlarged prostate or an infection, Strauss says. But a high level can lead to further screening, such as a prostate magnetic resonance imaging (MRI) scan, and then – if needed – a biopsy of prostate tissue to determine whether cancer is present.
The CU Anschutz Cancer Center offers advanced biopsy techniques that are more precise and have the potential to improve cancer detection and safety versus traditional methods.
Under current prostate cancer screening guidelines for healthy men not in an at-risk group, “the wide majority of men between ages 50 and 70 should receive screening,” Strauss says. “That would typically be a PSA test annually or every other year, depending on the PSA level.”
For those at risk – Black men, for example, or those who have a first-degree relative with prostate cancer – “we might recommend starting screening at age 40 or 45,” he says.
But the science on screening continues to evolve, Strauss says. “There are some studies and trials on now that are looking at earlier screening, and there's promising data on starting screening around age 40 and in putting people in different groups as far as how frequent the screening should be. I'm excited to see the data that will come out in coming years that may help us individualize PSA screening even more.”
Changing assumptions
The traditional upper age limit of 70 for routine prostate cancer screening is based in part of assumptions that a man above that age is more likely to die of other causes than of prostate cancer. But those assumptions are changing, Strauss says.
“It’s all about their overall health and fitness,” he says. “For me, chronological age is different from medical age. I still offer PSA screening and even biopsy to patients in their 70s and 80s, as long as they want to continue and we’ve had an open, informative conversation about it.”
If prostate cancer is diagnosed, urologists help patients understand that “not all prostate cancers are created equal,” Strauss says. Much depends on the cancer’s Gleason grade of one to five, a measure of how aggressive the cancer is – or, as Strauss puts it, how “angry” the cancer cells are. Grade 1 is considered low risk of growing rapidly, grades 2 and 3 are intermediate risk, and groups 4 and 5 are high risk, he says.
“For grade 1 patients, the recommendations are to do an active surveillance protocol – essentially a repeat of PSA tests, MRIs, and biopsies – but no treatment immediately,” he says. “Grades 2 through 5 are what we call clinically significant, meaning we want to treat the patient. The standard-of-care options could be surgical removal of the prostate – called a prostatectomy – or radiation therapy along with hormone medications.”
The CU Anschutz Cancer Center has “a very thoughtful group of urologists” and other specialists to treat patients with prostate cancer, Strauss says. Recently, some prostatectomies have been performed robotically, which can help men to maintain urinary continence. The cancer center also offers a multidisciplinary clinic where a variety of experts assess a prostate cancer patient’s case.
“I’ve been very happy with the oncologic outcomes and the quality of life we’ve been able to offer our patients,” he says.
→ Learn more about cancer screening here. If you have questions about screening, start a conversation with your medical provider about if and when you should be screened.
Photo at top: Jan Lowery, PhD, MPH, right, shows Steamboat Springs residents Jay Free and Carol Fugate information from the CU Anschutz Cancer Center’s ECCO mapping system during the Research Roadshow Oct. 17, 2025 at UCHealth Yampa Valley Medical Center. Photo by Suzie Romig/Steamboat Pilot & Today, used by permission.
