Prostate cancer: what to know, when to talk to your GP and what testing involves

Prostate cancer is one of the most commonly diagnosed cancers in Australia, yet many people are unsure about when testing should begin, what a prostate check involves, or what happens if a result is raised.

Unlike bowel cancer screening, there is no national screening program that automatically invites people to have a prostate cancer test. Instead, testing starts with a conversation with your GP about your age, family history, general health, personal risk and the possible benefits and limitations of testing. ^1,2

How common is prostate cancer?

An estimated 28,868 men were expected to be diagnosed with prostate cancer in Australia during 2025. It accounts for around 17 per cent of all newly diagnosed cancers, with around 79 Australian men diagnosed each day. One in five men is expected to receive a prostate cancer diagnosis during their lifetime. ³

Close to 4,000 men die from the disease each year, making it the second most common cause of cancer death among Australian men after lung cancer. At the end of 2021, 106,705 people were living with a prostate cancer diagnosis made during the previous five years. ³

Survival has improved substantially. Five-year relative survival increased from 60 per cent for men diagnosed between 1987 and 1991 to 96 per cent for those diagnosed between 2017 and 2021. Around 91 per cent live for ten years or more. ^3,4

Recorded diagnoses have also increased over time, from 3,607 in 1982 to 26,469 in 2021. Over the same period, the age-standardised incidence rate increased from 111 to 220 cases per 100,000 males. ³

When does risk increase?

Prostate cancer predominantly affects people later in life. More than 90 per cent of people diagnosed are aged 55 or older, and more than 85 per cent of Australian men diagnosed are over the age of 60. Incidence is expected to increase with age up to 75 to 79 years. ^3,5

What can increase your risk?

Four risk factors are described as proven: increasing age, family history, genetic changes such as BRCA2 mutations, and Black sub Saharan African ancestry. ^6,5

Family history is particularly important because it can affect the age at which testing is worth discussing. Around 15 per cent of prostate cancer cases in Australia occur among men with a family history of the disease. ⁶

You may be at least twice the usual risk if you have a brother diagnosed with prostate cancer at any age, or a father diagnosed before age 65. Risk may also be higher if two or more second degree relatives, such as an uncle or grandfather, died from prostate cancer, if you have a confirmed BRCA2 mutation, or if you have Black sub Saharan African ancestry. ^6,2

The cause of prostate cancer itself is not known. There is no established way to prevent it, and no strong link between diet or lifestyle and the disease has been demonstrated. Risk factors tell us about likelihood across a population. They cannot explain why one particular person develops prostate cancer. ^7,6

When should you talk to your GP about testing?

Current Australian guidance recommends that from age 50, men are given the opportunity to discuss prostate cancer risk and the possible benefits and harms of testing with their GP. For those who choose to test, the usual interval is every two years between ages 50 and 69. ^2,8

For people at higher risk, testing from age 45 may be appropriate. Beyond age 70, the decision is more individual and takes into account general health and personal preferences, because the benefits of early detection may take a number of years to become apparent. ^2,8

Anyone with a prostate can develop prostate cancer. This includes transgender women, people assigned male at birth who identify as non binary, and some intersex people. ⁵

Can prostate cancer develop without symptoms?

Yes. Early prostate cancer rarely causes symptoms, and prostate cancer may sometimes cause no symptoms even when it is advanced. Feeling well therefore does not necessarily mean there is nothing to discuss with your GP. ^9,7

When symptoms do occur, they may include a weak urine flow, a flow that stops and starts, needing to urinate urgently or frequently, difficulty starting urination, or feeling that the bladder has not fully emptied.

Other possible symptoms include pain, blood in the urine or semen, back pain, weakness in the legs, weight loss, fatigue, shortness of breath, dizziness or pale skin. ⁹

Many other conditions can cause these symptoms, so having them does not mean you have prostate cancer. They should, however, be discussed with your GP. Blood in the urine should never be ignored. If you have symptoms, make an appointment rather than waiting for a future routine testing interval. ^9,7

What happens at a prostate cancer check?

For most people, the appointment starts with a conversation.

Your GP will consider your age, family history, general health and any symptoms. They will explain what testing can and cannot tell you and discuss the possible benefits and harms. Current guidance places considerable importance on having this discussion before testing. ^2,10

If you decide to proceed, the first test is a blood test known as a PSA test.

You do not need to decide before seeing your GP. You can use the appointment to understand your options and reconsider testing later if you choose. ²

Why discuss the test before having it?

PSA testing can detect prostate cancers that may never have caused symptoms or harm during a person’s lifetime. This is known as overdiagnosis. ^1,2,11

Overdiagnosis matters because finding a cancer can sometimes lead to treatment that may not have been necessary. Treatment can have side effects including sexual impotence, urinary incontinence and bowel problems. ^1,2

The decision involves balancing the benefit of finding a significant cancer early against the possibility of treating a cancer that may never have caused harm. Your GP can help you consider that balance. ^2,11

Does a prostate check involve a rectal examination?

Not as part of a routine prostate cancer check in general practice.

National guidance changed in May 2026. A digital rectal examination is no longer routinely offered in general practice as an addition to PSA testing. ^2,10,12

If results lead to specialist referral, an examination may still form part of the specialist assessment before any decision about a biopsy. ²

What is a PSA test?

PSA stands for prostate specific antigen. The blood test measures the level of PSA, which is produced mainly by the prostate gland. The expected range varies with age. ^2,8

A PSA test does not specifically test for cancer. PSA can rise for several reasons, so a single raised result does not mean you have prostate cancer. ^1,2

If you choose to test, your GP provides a pathology request and the result is returned to them after your blood test.

What happens if the PSA result is raised?

A raised PSA result is not a prostate cancer diagnosis.

If a result is above the level expected for your age and risk, current guidance recommends repeating the test within one to three months. If the repeat result remains raised, referral to a urologist follows. ^2,8

The next investigation is generally an MRI scan rather than going directly to a biopsy. The MRI helps determine whether a biopsy is warranted. ^2,8

If prostate cancer is found and assessed as low risk, immediate treatment may not be necessary. Monitoring is now the usual approach for many people with low risk disease.

More than 80 per cent of men in this position choose monitoring, which can avoid treatment side effects including incontinence and sexual dysfunction. ^2,8

What does PSA testing cost?

Medicare funds PSA testing at the recommended intervals and allows more frequent testing for men whose father or brother has had prostate cancer. ¹³

Whether there is a cost for the blood test depends on whether the pathology provider bulk bills the collection. Your GP consultation is billed separately from the pathology test. ¹³

Before your appointment

A little preparation can help you get more from the conversation.

If possible, find out whether your father, brothers, uncles or grandfathers have had prostate cancer and the age at which they were diagnosed. Family history may influence when testing should be discussed. ^6,2

If you have had a PSA test before, let your GP know when it was performed because testing intervals are based on your previous test date. ²

If you are experiencing urinary changes, blood in your urine or semen, unexplained pain or any of the other symptoms described above, do not wait for a routine testing interval. Make an appointment to discuss them with your GP. ^9,7

The place to start is a conversation

Prostate cancer testing is not simply a matter of reaching a certain age and having a blood test.

The current approach is based on informed decision making, which means understanding your individual risk, the potential benefits of testing and what a result may mean for you. ^2,11

You do not need to work this out on your own.

If you are approaching the age when testing is usually discussed, have a family history of prostate cancer, are concerned about your risk or are experiencing symptoms, speak with your GP. They can help you understand what is appropriate for you and what the next step, if any, should be.

This article is general information only and is not a substitute for individual medical advice. Speak with your GP about your own circumstances.

References