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As a GP, I genuinely wish I had more conversations with men about prostate cancer tests than I currently do.
In Australia, around 3,500 men die from prostate cancer each year. That’s a significant number, and one that often feels preventable when we catch problems early.
So if you’re wondering whether it’s worth bringing up at your next appointment, the short answer is: yes.
ON THIS PAGE
- What is prostate cancer?
- Symptoms
- Diagnosis: There’s no perfect test
- The PSA blood test
- What about the digital rectal examination?
- My advice as a GP
- About Dr Michael Macpherson
For many men, though, the word prostate immediately brings anxiety.
This is usually because they’re picturing a digital rectal examination. Understandably, that’s not anyone’s favourite thought.
But here’s the good news: There are less invasive ways to assess prostate health, and a simple conversation is often the most important first step.
What is Prostate Cancer?
The prostate is a small gland that sits just below the bladder in men (women don’t have one). It produces much of the fluid that makes up semen and helps nourish sperm.
Like many organs in the body, the prostate can develop cancer.
There are different types of prostate cancer:
- Most are slow-growing and may never cause harm. Many are discovered incidentally as men age.
- Some are aggressive and can spread quickly to other parts of the body if not detected early.
Risk factors include:
- Increasing age
- A family history of prostate cancer (especially in male relatives diagnosed under 65)
- Lifestyle factors such as smoking, excess alcohol, and low physical activity
Age is the biggest risk factor, which is why these conversations become more important over time.
What are the Symptoms of Prostate Disease?
Prostate cancer is just one of three common prostate conditions. The other two are:
- Prostatitis (inflammation, which can affect men of all ages)
- Benign Prostatic Hyperplasia (BPH) — a non-cancerous enlargement of the prostate, particularly common in older men
Symptoms of prostate issues may include:
- Changes in urinary flow (weak stream or “stop-start” urination)
- Difficulty starting urination
- Urgency (suddenly needing to go)
- Dribbling or reduced control
- Waking more frequently at night than usual to urinate
Importantly, these symptoms don’t automatically mean cancer. BPH commonly causes them too.
But if you’ve noticed any changes over the past 3–6 months, then hotfoot it to your GP for a chat.
There’s No Perfect Test for Prostate Cancer
Unlike bowel, breast, or cervical cancer, which have well-established screening programs, prostate cancer doesn’t have a single reliable, clear-cut screening test.
That’s partly why there’s an ongoing debate in the medical community about routine screening.
Many prostate cancers detected through screening are low-risk and slow-growing. These may never cause harm — but diagnosing them can sometimes lead to unnecessary biopsies, treatments, and side effects.
It’s not a simple “test everyone” situation.
That’s why decisions are best made individually, based on your age, risk factors, and preferences.
PSA Blood Test
The most commonly used screening tool is the prostate-specific antigen (PSA) blood test.
PSA is a protein produced by the prostate. Elevated levels can indicate a problem, but unfortunately, not always cancer.
PSA levels can rise due to:
- Recent exercise
- Recent ejaculation
- Benign prostate enlargement
- Infection or inflammation
- Even a recent prostate examination
It can also occasionally be normal in someone with early prostate cancer.
In other words, it’s helpful but certainly not perfect.
What About the Digital Rectal Examination?
Yes, it involves a gloved finger. No, it’s not pleasant.
But it’s quick, and for many men, far less dramatic than they imagine.
That said, such a test isn’t always necessary. It can be useful if there are symptoms or concerns about prostate enlargement, but it’s just one part of the overall picture.
My Advice as a GP
Have a conversation with your GP if you’re:
- Over 50
- Over 40 with a family history of prostate cancer
- Or simply feeling worried
That conversation might lead to:
- Monitoring symptoms over time
- A PSA blood test
- A prostate examination
- Imaging such as ultrasound or MRI
- Referral to a urologist if needed
Or it may reassure you that everything sounds normal.
The Bottom Line
I talk about prostates every single day.
There’s nothing embarrassing about it. Nothing unusual. Nothing awkward from our perspective.
In fact, most men feel noticeably less anxious after having the conversation, even if we decide not to do any tests straight away.
So if it’s been on your mind, bring it up.
Your future self will thank you.
Dr Michael Macpherson (BAppSc, MBBS, FRACGP) is a local GP at Doctors of South Melbourne.
He has special interests in men’s health and chronic disease management.
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