New prostate cancer advice: Black men should start PSA checks at 45

Why this matters in Zimbabwe

Prostate cancer is the most common cancer in Zimbabwean men. About 3,635 men are diagnosed each year, and it's the leading cause of cancer death in men here, with around 2,300 deaths a year.

In the US, Black men are 67% more likely to get prostate cancer than White men and nearly twice as likely to die from it. That's why the new guideline puts Black men in the higher-risk group, and most Zimbabwean men fall into it.

What changed

The old 2010 advice was to talk it over with your doctor and decide. The new advice is a direct recommendation to get screened, because longer-running trials now show clearer benefits, and doctors have better ways to avoid unnecessary biopsies and treatment.

PSA test every yearPSA test every 2 years

Strong family history: a father or brother diagnosed before 65, or 2 or more diagnosed at any age.

What if my PSA is high?

This is the part that's changed most. A high PSA used to lead quickly to a biopsy. Now there are extra steps in between, to make sure only men who really need a biopsy have one.

1. 🩸PSA blood testA simple blood test. High means 3.0 or more (ages 45 to 69), or 6.5 or more (ages 70 to 74).
2. 🔁Repeat itPSA can rise for other reasons, like an infection or an enlarged prostate. Repeat in 2 weeks to 3 months.
3. 🧠MRI or extra testStill high? An MRI scan and/or a validated blood or urine test helps decide who needs a biopsy.
4. 🔬Biopsy only if neededIf the scan or test suggests a significant cancer, a biopsy confirms it.
5. 👁Watch or treatLow-risk cancer is watched closely (active surveillance). Higher-risk cancer is treated.

These extra steps work. In a Swedish trial, screening with PSA plus an MRI before biopsy halved the number of harmless cancers diagnosed, from 1.2% to 0.6% of men, while still finding the cancers that matter.

Does screening actually save lives?

Yes, though the benefit is modest for any one man, and that's worth knowing. The largest trial followed men in Europe for 23 years.

13%fewer prostate cancer deaths in men invited to screening

1 per 456one prostate cancer death prevented for every 456 men invited

23 yearsof follow-up in 162,236 men in 8 European countries

Source: Roobol MJ, et al. N Engl J Med. 2025.

For every 12 men diagnosed through screening, one avoided dying from prostate cancer.

The downsides, honestly

• False alarms: PSA can be high without cancer, which causes worry and more tests
• Overdiagnosis: some cancers found would never have caused harm
• Biopsy risks: bleeding and, rarely, infection
• Treatment side effects: problems with erections or bladder control

The new guideline tackles these directly: repeat tests and MRI before biopsy, and watching low-risk cancers instead of treating them straight away.

What is active surveillance?

If a cancer is small and slow-growing, you may be offered active surveillance instead of surgery or radiotherapy. That means regular PSA tests, scans and sometimes repeat biopsies, with treatment only if the cancer changes. Many men never need treatment.

Symptoms to look out for

Early prostate cancer usually causes no symptoms, which is why testing matters. Problems passing urine are more often caused by a harmless enlarged prostate, but they're worth checking. See a doctor soon if you notice blood in your urine or semen, or new pain in your back, hips or bones.

What to do now

• Find your group in the table above
• If you're due, book a PSA blood test. It's a simple blood test at the clinic
• Ask your father, brothers and uncles whether anyone has had prostate cancer, and at what age
• Keep a copy of every PSA result. Your doctor will look at how it changes over time

November is men's health month. Share this with the men in your life.