Prostate Screening in BC: PSA Testing, When to Get Checked, and What to Expect

Last Updated: May 2026

This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider.

Prostate health is a topic many men avoid discussing, yet prostate cancer remains the most commonly diagnosed cancer among Canadian men. In British Columbia alone, approximately 4,000 men are diagnosed with prostate cancer each year. Understanding when and how to get screened can help you make informed decisions about your health.

This guide explains everything BC men need to know about prostate screening, including PSA testing, current provincial guidelines, what happens if results are abnormal, and how to access care through the BC healthcare system.

Understanding the Prostate and Why Screening Matters

The prostate is a small, walnut-sized gland located below the bladder and in front of the rectum. It produces seminal fluid that nourishes and transports sperm. As men age, the prostate commonly enlarges, which can cause urinary symptoms even without cancer being present.

Prostate cancer often grows slowly and may not cause symptoms in its early stages. When caught early and confined to the prostate gland, the five-year survival rate exceeds 99%. However, once cancer spreads beyond the prostate, treatment becomes more complex and outcomes less favourable.

This is why screening conversations matter. The challenge is that prostate screening involves trade-offs between potential benefits (early detection of aggressive cancer) and potential harms (unnecessary biopsies, overdiagnosis of slow-growing cancers that may never cause problems). Understanding these trade-offs helps you have a meaningful conversation with your doctor.

PSA Testing: What It Measures and What It Means

What Is a PSA Test?

The prostate-specific antigen (PSA) test is a blood test that measures the level of PSA, a protein produced by both normal and cancerous prostate cells. Elevated PSA levels can indicate prostate cancer, but they can also result from non-cancerous conditions.

It is important to understand that a PSA test is not a definitive cancer test. It is a screening tool that identifies men who may benefit from further investigation.

Normal PSA Ranges by Age

PSA levels naturally increase with age as the prostate grows. Generally accepted reference ranges are:

Ages 40-49: 0 to 2.5 ng/mL
Ages 50-59: 0 to 3.5 ng/mL
Ages 60-69: 0 to 4.5 ng/mL
Ages 70-79: 0 to 6.5 ng/mL

These ranges are guidelines, not absolute thresholds. Some men with cancer have PSA levels within the "normal" range, while many men with elevated PSA do not have cancer.

Factors That Can Elevate PSA (Besides Cancer)

Several benign conditions can raise PSA levels:

Benign prostatic hyperplasia (BPH): Non-cancerous prostate enlargement
Prostatitis: Infection or inflammation of the prostate
Recent ejaculation: Can temporarily elevate PSA
Urinary tract infection: Can cause temporary elevation
Recent prostate examination or procedures: Including digital rectal exam or catheterization
Cycling: Prolonged cycling may temporarily raise PSA in some men

Your doctor may ask about these factors before ordering a PSA test or interpreting results.

Limitations of PSA Testing

PSA testing has significant limitations that have shaped current screening guidelines:

False positives are common. Approximately 75% of men with elevated PSA who undergo biopsy do not have cancer. This leads to unnecessary procedures, anxiety, and potential complications from biopsies.

False negatives occur. Some men with prostate cancer have normal PSA levels, particularly with certain aggressive cancer types.

Overdiagnosis is a concern. PSA testing can detect slow-growing cancers that would never cause symptoms or death during a man's lifetime. Treating these cancers exposes men to side effects (incontinence, erectile dysfunction) without benefit.

PSA velocity and density. Doctors sometimes consider how quickly PSA rises over time (velocity) or the ratio of PSA to prostate size (density) to improve accuracy, though these measures also have limitations.

BC Screening Guidelines: A Shared Decision-Making Approach

BC Cancer's Position on Routine PSA Screening

BC Cancer does not recommend routine PSA screening for men at average risk of prostate cancer. This position aligns with the Canadian Task Force on Preventive Health Care and reflects the evidence that population-wide screening causes significant harms without clear overall mortality benefit.

However, this does not mean screening is never appropriate. BC Cancer recommends a shared decision-making approach where men discuss the potential benefits and harms of screening with their healthcare provider, then make an individual choice based on their values and risk factors.

Who Should Consider Screening

Average-risk men ages 50 to 70 may choose to have PSA testing after discussing the pros and cons with their doctor. The conversation should cover:

The possibility of detecting cancer early
The likelihood of false positive results leading to unnecessary biopsies
The risk of overdiagnosis and overtreatment
The potential side effects of treatment
The man's overall health, life expectancy, and personal preferences

Higher-risk men should consider discussing screening at an earlier age:

Men with a first-degree relative (father, brother) diagnosed with prostate cancer: Consider discussion starting at age 40 to 45
Black men: Have higher incidence and mortality rates from prostate cancer and should consider discussion starting at age 40 to 45
Men with known BRCA1 or BRCA2 gene mutations: Should discuss screening with their healthcare provider, potentially starting at age 40

Men over 70 or those with less than 10 years of life expectancy are generally not recommended for screening, as they are unlikely to benefit and more likely to experience harms.

Making an Informed Decision

There is no single "right" answer about whether to get screened. Some men, after understanding the trade-offs, choose regular PSA testing for peace of mind and the chance to catch aggressive cancer early. Others decide the risks of overdiagnosis and unnecessary treatment outweigh the potential benefits.

Both choices are reasonable. What matters is that you make an informed decision rather than having screening done automatically without discussion.

How to Get a PSA Test in BC

Through Your Family Doctor or Nurse Practitioner

The most common pathway to PSA testing in BC is through your family doctor or nurse practitioner. If you want to discuss prostate screening:

Book an appointment specifically to discuss prostate health
Your provider will review your risk factors, family history, and overall health
If you both agree screening is appropriate, your provider will order the blood test
You will have blood drawn at a LifeLabs location or hospital laboratory
Results typically return within a few days

MSP (Medical Services Plan) covers PSA testing when ordered by a physician or nurse practitioner for clinical purposes. You will not pay out of pocket for the blood test itself.

Private PSA Testing

Some men without a family doctor, or those who prefer not to involve their doctor, choose private PSA testing. Several options exist in BC:

LifeLabs (private pay): Offers PSA testing for approximately $35 to $50 without a doctor's requisition at select locations. You receive results directly.

Private health clinics: Some private clinics offer PSA testing as part of executive health assessments or men's health panels, typically ranging from $50 to $150 depending on what other tests are included.

Home collection services: Some companies offer at-home blood collection kits for PSA testing, though availability and pricing vary.

If you pursue private testing and receive an abnormal result, you will still need to see a doctor for follow-up care. Consider this before choosing private testing, as the cost savings may be minimal compared to simply having the conversation with your healthcare provider.

For more information about private diagnostic options in BC, visit our guide at /private-diagnostics.

What Happens If Your PSA Is Elevated

An elevated PSA result does not mean you have cancer. It means further evaluation is needed to determine the cause. Here is what typically happens next.

Repeat PSA Testing

Often, the first step is simply repeating the PSA test in four to six weeks. Temporary elevations from infection, recent ejaculation, or other factors may resolve. Your doctor may also ask you to avoid ejaculation for 48 hours before the repeat test and ensure you do not have a urinary tract infection.

Digital Rectal Examination

Your doctor will likely perform a digital rectal examination (DRE), feeling the prostate through the rectum to check for abnormalities in size, shape, or texture. While somewhat uncomfortable, this examination takes only a minute and provides valuable information.

Referral to a Urologist

If PSA remains elevated or other concerning findings are present, your doctor will refer you to a urologist (a specialist in urinary tract and male reproductive conditions).

Wait times for urologist appointments in BC vary by health authority and urgency. For suspected cancer, referrals are typically prioritized. Current wait times range from a few weeks to several months depending on your region. Your family doctor can indicate urgency on the referral to help expedite the process.

For information about accessing specialists in BC, including how to navigate wait times, visit our guide at /specialist-access.

Multiparametric MRI (mpMRI)

Increasingly, BC urologists use multiparametric MRI before biopsy. This specialized MRI provides detailed images of the prostate and can identify suspicious areas that warrant biopsy while also identifying men who may safely avoid biopsy.

mpMRI is available at major centres across BC, including:

Vancouver General Hospital
BC Cancer centres
Royal Jubilee Hospital in Victoria
Kelowna General Hospital
Select private imaging facilities

Wait times for prostate MRI through the public system vary, though urgent cases are prioritized. Some men choose private MRI to reduce wait times, with costs typically ranging from $800 to $1,500 out of pocket.

Prostate Biopsy

If MRI shows suspicious areas, or if clinical judgment supports it, a prostate biopsy may be recommended. Modern biopsies in BC are often MRI-guided or MRI-fusion biopsies, which target suspicious areas identified on imaging rather than sampling randomly throughout the prostate.

This approach, available at major BC centres, has been shown to:

Detect more clinically significant cancers
Reduce detection of insignificant cancers that do not require treatment
Reduce the number of biopsy cores needed
Potentially reduce complications

Biopsy is typically performed as an outpatient procedure. You may receive antibiotics to prevent infection and will be given specific preparation instructions.

Prostate Cancer Treatment Options in BC

If biopsy confirms prostate cancer, treatment depends on the cancer's grade (aggressiveness), stage (extent of spread), your age, overall health, and personal preferences. Here is a brief overview of options available in BC.

Active Surveillance

For low-risk, slow-growing prostate cancer, active surveillance is often recommended. This involves:

Regular PSA testing (typically every three to six months initially)
Periodic repeat biopsies
MRI monitoring

The goal is to avoid or delay treatment and its side effects for cancers that may never cause harm, while monitoring closely to intervene if the cancer shows signs of progression.

Active surveillance is not the same as doing nothing. It is a structured monitoring program that has proven safe and effective for appropriately selected men.

Surgery (Radical Prostatectomy)

Surgical removal of the prostate is a common treatment for localized prostate cancer. In BC, robotic-assisted prostatectomy is available at several centres, including Vancouver General Hospital and Royal Jubilee Hospital.

Robotic surgery offers potential benefits including smaller incisions, reduced blood loss, and potentially faster recovery, though outcomes depend significantly on surgeon experience.

Wait times for prostate cancer surgery in BC vary but are generally within the provincial cancer surgery targets. Your urologist and BC Cancer will coordinate care to ensure timely treatment.

Radiation Therapy

Radiation therapy, including external beam radiation and brachytherapy (internal radiation seeds), is available through BC Cancer centres across the province. Radiation can be as effective as surgery for localized prostate cancer and may be preferred for older men or those with other health conditions.

BC Cancer coordinates all cancer radiation treatment in the province, ensuring consistent quality and access across regions.

Hormone Therapy

Hormone therapy (androgen deprivation therapy) reduces testosterone levels, which prostate cancer cells need to grow. It may be used:

In combination with radiation therapy
For cancer that has spread beyond the prostate
For cancer that returns after initial treatment

Hormone therapy has significant side effects including hot flashes, loss of libido, fatigue, and bone loss, which your oncologist will discuss with you.

Making Treatment Decisions

BC Cancer provides multidisciplinary cancer conferences where specialists review cases and provide treatment recommendations. You will work with your healthcare team to understand options, potential outcomes, and side effects before making decisions.

BPH: When an Enlarged Prostate Is Not Cancer

Benign prostatic hyperplasia (BPH) is extremely common in aging men. By age 60, approximately 50% of men have some degree of BPH. By age 85, up to 90% are affected.

BPH is not cancer and does not increase cancer risk, but it can cause bothersome symptoms that affect quality of life.

Common BPH Symptoms

Frequent urination, especially at night
Difficulty starting urination
Weak urine stream
Dribbling at the end of urination
Feeling that the bladder does not empty completely
Urgency to urinate

BPH Treatment Options

Treatment depends on symptom severity:

Watchful waiting: For mild symptoms, simply monitoring without treatment may be appropriate.

Medications: Alpha-blockers (tamsulosin, alfuzosin) relax prostate muscles to improve urine flow. 5-alpha reductase inhibitors (finasteride, dutasteride) can shrink the prostate over time. Note that finasteride and dutasteride can lower PSA levels, which must be accounted for in prostate cancer screening.

Minimally invasive procedures: Options include Urolift, Rezum (water vapor therapy), and others that can be performed as outpatient procedures.

Surgery: Transurethral resection of the prostate (TURP) remains an option for larger prostates or severe symptoms.

Your family doctor can often manage mild BPH with medication. More significant symptoms may warrant urology referral.

When to See a Doctor About Prostate Symptoms

Do not wait for a screening discussion if you experience:

Blood in urine (hematuria): Should always be evaluated promptly
Blood in semen: While often benign, warrants evaluation
Difficulty urinating or complete inability to urinate: Urinary retention is a medical emergency
Persistent pelvic, hip, or lower back pain: Especially if new or worsening
Unintentional weight loss with urinary symptoms
Bone pain: Especially in the spine, hips, or ribs

These symptoms do not necessarily indicate cancer. Many have benign causes. However, they warrant medical evaluation regardless of your screening preferences.

If you are experiencing urinary symptoms and do not have a family doctor, call HealthLinkBC at 811 for guidance on accessing care.

Frequently Asked Questions

At what age should men start thinking about prostate screening in BC?

Average-risk men should consider having a conversation with their healthcare provider about prostate screening starting at age 50. Men at higher risk (those with a father or brother diagnosed with prostate cancer, Black men, or those with known BRCA mutations) should consider this discussion at age 40 to 45. The conversation is about understanding the benefits and harms of screening to make an informed personal choice.

Does MSP cover PSA testing in BC?

Yes, MSP covers PSA testing when ordered by a physician or nurse practitioner for clinical purposes. If you and your doctor agree that screening is appropriate after discussing risks and benefits, the test is covered. You will not pay for the blood draw. Private testing without a doctor's order is also available for approximately $35 to $80 at private labs.

How often should I get a PSA test if I choose to be screened?

For men who choose screening, testing every two to four years is generally considered reasonable for those with low baseline PSA. Men with higher PSA levels (but still below the threshold for further investigation) may be tested more frequently. Your doctor will recommend an interval based on your individual results and risk factors.

What is a "normal" PSA level?

Normal ranges increase with age. Generally, PSA below 2.5 ng/mL is considered normal for men in their 40s, with the upper limit increasing to around 6.5 ng/mL for men in their 70s. However, there is no absolute "safe" number. Some men with cancer have low PSA, while many men with elevated PSA do not have cancer. Trends