
Combating Prostate Cancer Misconceptions in Primary Care: An Expert Discussion
Mina Fam, MD, addresses common prostate cancer misconceptions involving symptoms, elevated PSA, biopsy, and active surveillance.
The absence of urinary symptoms does not exclude prostate cancer, and an elevated prostate-specific antigen (PSA) level does not establish the diagnosis, Mina Fam, MD, a urologic oncologist at Hackensack Meridian Health in New Jersey, explained in a recent interview with Patient Care Online. Some patients delay screening because they feel well, while others assume an abnormal test means cancer and immediate treatment.
Localized prostate cancer often causes no symptoms. Urinary frequency, urgency, weak stream, and nocturia are common with benign prostatic hyperplasia and do not reliably indicate whether cancer is present. Bone pain, weight loss, or progressive urinary obstruction may occur with more advanced disease, but screening is intended to identify risk earlier. The National Cancer Institute also cautions that PSA can be elevated for reasons other than cancer and that false-positive results can lead to additional testing and biopsy.¹
Fam encourages primary care clinicians to make the first conversation less intimidating. An abnormal PSA can be reassessed before an invasive procedure is considered. Evaluation may include repeat testing, risk calculators, biomarkers, or prostate MRI. The 2023 AUA/SUO biopsy guideline supports selective use of adjunctive urine or serum markers when results would influence the biopsy decision and recommends MRI-informed decision-making rather than treating one threshold as definitive.²
A prostate cancer diagnosis also does not automatically require immediate definitive treatment. Active surveillance is a structured management strategy for appropriately selected patients with low-risk disease, using serial PSA testing, examinations, imaging, and repeat biopsy as indicated. In the 15-year ProtecT trial of men with localized prostate cancer, prostate cancer mortality remained low regardless of whether patients initially underwent active monitoring, prostatectomy, or radiotherapy, although metastases and clinical progression were more frequent with monitoring.³ The findings reinforce the importance of matching management to disease risk and patient priorities.
The counseling goal is balanced reassurance: screening can matter without symptoms, but neither an elevated PSA nor a diagnosis should be interpreted without risk stratification and a discussion of options.
Fam has no relevant disclosures.
References
1. National Cancer Institute. Prostate Cancer Screening (PDQ®)–Patient Version. Updated on December 10, 2024. Accessed September 16, 2026.
2. Wei JT, Barocas D, Carlsson S, et al. Early Detection of Prostate Cancer: AUA/SUO Guideline Part II: Considerations for a Prostate Biopsy. J Urol. 2023;210:54-63.
3. Hamdy FC, Donovan JL, Lane JA, et al. Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. N Engl J Med. 2023;388:1547-1558.


























































































































