Most men will service the car on schedule, check the oil before a long drive, and put up the shutters before hurricane season. Yet the same men can go years without a single conversation about their own health. Let's change that.
Prostate cancer is one of the most important men's health topics in The Bahamas and across the Caribbean, and it is also one of the most debated topics in medicine. Experts do not all agree on who should be screened, when, or how often. That is exactly why it deserves a real conversation rather than a one-size-fits-all rule. My goal in this post is not to tell you to get tested. It is to help you make the decision on purpose, with good information.
Why This Matters Especially for Caribbean Men
A review of the published research on prostate cancer in the Caribbean concluded that Afro-Caribbean men face a higher risk of the disease than any other population of men in the world, and that the region carries one of the heaviest burdens of prostate cancer cases and deaths anywhere. In other words, this is not a distant problem. It is a local one.
The U.S. Preventive Services Task Force, which publishes the best-known screening guideline, recognises that risk is not the same for every man. It asks doctors and patients to weigh family history, race and ethnicity, other health conditions, and personal values when deciding about screening. At the same time, the Task Force acknowledged that the research is not yet strong enough to give higher-risk groups, such as men with a family history, their own separate screening schedule, and it called for more research. In plain terms: your risk is not your neighbour's risk, and the guidelines are still catching up.
What "Screening" Actually Means
Prostate cancer screening usually means a PSA test: a simple blood test that measures prostate-specific antigen, a protein made by the prostate gland. A raised PSA is a signal to look more closely, not a diagnosis. PSA can rise for reasons other than cancer, and screening is meant for men who have no symptoms. Many men with prostate cancer never have symptoms and, without screening, would never know they have it, which is both the promise and the problem of testing.
So who should be having this conversation, and when?
The Honest Balance: Benefits and Harms
Here is what makes prostate screening unusual in medicine: it can save lives, and it can cause harm. Both statements are true, and a good decision means looking at both.
On the benefit side, the European Randomized Study of Screening for Prostate Cancer (ERSPC), a very large trial run across eight European countries, found fewer prostate cancer deaths among men offered regular PSA screening. The absolute benefit grew the longer the men were followed.
The trade-off is real: screened men were also diagnosed with more cancers overall, including some that would never have caused them harm.
The Task Force weighed this and other evidence and concluded that screening offers a small potential benefit for some men aged 55 to 69. It estimated that screening may prevent about 3 cases of metastatic prostate cancer for every 1,000 men screened. On the other side of the scale are the potential harms: false-positive results that lead to worry and unnecessary biopsies, complications from biopsies, the diagnosis of slow-growing cancers that never needed treatment (overdiagnosis), and the side effects of treatment, such as urinary incontinence and erectile dysfunction.
Screening isn't a test you pass or fail.
It's a decision you make with your doctor, with your eyes open.
Guidance in this area also keeps evolving. The Task Force has an update to its recommendation in progress, which is one more reason to revisit the decision with your doctor rather than rely on something you read years ago, including this blog.
Your Simple Prostate Health Action Plan
Ask your father, brothers, and uncles whether anyone has had prostate cancer, and at what age. Write it down and bring it to your appointment. It is some of the most useful information you can give your doctor, and it costs nothing.
A PSA test should never be ordered or declined in a hurry. At your visit, we talk through your age, ancestry, family history, other health conditions, and what matters most to you, and then decide together. That shared decision-making approach is exactly what the Task Force recommends for men aged 55 to 69.
A raised PSA does not mean you have cancer. In the PRECISION trial, men with a raised PSA who had an MRI first, and were biopsied only if it showed a suspicious area, were diagnosed with significantly fewer low-risk cancers than men who went straight to a standard biopsy, while clinically significant cancers were found at least as well. About 1 in 4 men in the MRI group (28%) avoided a biopsy altogether. Access to MRI varies, so ask what is available locally and whether a referral makes sense.
Many prostate cancers found through PSA testing are localized and slow-growing. In the ProtecT trial, which followed 2,664 men with localized prostate cancer for a median of 15 years, fewer than 3 in 100 (2.7%) died of prostate cancer, whether they were assigned to active monitoring, surgery, or radiotherapy. Surgery and radiotherapy lowered the chance of the cancer progressing but did not lower the chance of dying from it, so the choice involves weighing benefits against side effects. That decision belongs with you and your specialist, and active monitoring can be a legitimate option for suitable men.
Screening is not a one-time choice. Your age, health, and circumstances change, and so does the evidence. Make it a standing item at your regular check-ups so the decision stays current rather than being settled once and forgotten.
- Given my age, ancestry, and family history, what is my personal risk?
- What are the benefits and harms of a PSA test for me specifically?
- If my PSA is raised, would an MRI come before a biopsy, and is it available here?
- If cancer were found, would active monitoring be an option for me?
- How often should we revisit this decision?
Make It a Family Affair
Prostate health is rarely a one-person conversation. The men in your family, your fathers, brothers, and sons, share part of your risk, and the women who love you often notice what you will not say out loud. If you are a wife, partner, or daughter reading this, consider sending this post to the man in your life. If you are a man reading this, consider it permission to make the appointment. In a region where Caribbean men carry such a heavy burden of this disease, silence is the thing we can least afford.
The screening conversation usually begins with a simple blood test and a talk. It does not have to be intimidating, and it does not have to commit you to anything. Asking the question is the first step, and the only one that is entirely in your hands.
A Note From My Desk to Yours
I cannot tell you in a blog post whether you should have a PSA test. The honest answer is that it depends on your age, your family, your ancestry, your health, and what matters to you. What I can tell you is that the decision deserves to be made on purpose, with good information, rather than by default or by avoidance.
Make the appointment before you have a reason to.
Bring your questions and your family history, and we will work through it together, with no judgement and no pressure. We are here for the whole family, at every stage.
References
The following peer-reviewed sources, published between 2018 and 2023, informed this article. All references have been verified and meet current evidence-based standards.
- Khandwala, Y. S., Ohanian, A., & Huang, F. W. (2022). Prostate cancer in the Caribbean: A baseline assessment of current practices and potential needs. Cancer Control, 29, 1–8. https://doi.org/10.1177/10732748221082372
- US Preventive Services Task Force, Grossman, D. C., Curry, S. J., Owens, D. K., Bibbins-Domingo, K., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Ebell, M., Epling, J. W., Jr., Kemper, A. R., Krist, A. H., Kubik, M., Landefeld, C. S., Mangione, C. M., Silverstein, M., Simon, M. A., Siu, A. L., & Tseng, C.-W. (2018). Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA, 319(18), 1901–1913. https://doi.org/10.1001/jama.2018.3710
- Hugosson, J., Roobol, M. J., Månsson, M., Tammela, T. L. J., Zappa, M., Nelen, V., et al. (2019). A 16-yr follow-up of the European Randomized Study of Screening for Prostate Cancer. European Urology, 76(1), 43–51. https://doi.org/10.1016/j.eururo.2019.02.009
- Kasivisvanathan, V., Rannikko, A. S., Borghi, M., et al.; PRECISION Study Group Collaborators. (2018). MRI-targeted or standard biopsy for prostate-cancer diagnosis. New England Journal of Medicine, 378(19), 1767–1777. https://doi.org/10.1056/NEJMoa1801993
- Hamdy, F. C., Donovan, J. L., Lane, J. A., Metcalfe, C., Davis, M., Turner, E. L., et al.; ProtecT Study Group. (2023). Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. New England Journal of Medicine, 388(17), 1547–1558. https://doi.org/10.1056/NEJMoa2214122