No prostate screening at all for me. Not my decision — the major hospital where I go for checkups now has a policy of not screening because they say that, on the whole, the good that these tests do is offset by the harm of false positives.
Unfortunately, that's old news... the problem was that biopsies have their own risks, and of course, the false positive issue. However, the standard of care now is to perform the PSA test, and if the result doubles within a year, or the absolute number is above the threshold for your age (4.0 for those under 60), then perform a multi-protocol MRI, MPMRI. This non-invasive test identifies the location of any prostate tumors, and gives a VERY good idea on whether any tumor found is likely to be cancerous or not.
Then, you can proceed to have a biopsy, if suspicious tumors are found, and the biopsy can be guided by the MRI. In fact, some facilities have computer power to merge the biopsy doctor's ultrasound image with the MRI image to give a real-time roadmap for biopsy needle placement. Pretty cool stuff.
If you only have one tumor, there are now laser treatment options that are one and done. No surgery, no multiple trips to the radiology lab.
It's a brave new world to prevent prostate cancer running away... you don't want to be the 1 in one thousand with serious, invasive prostate cancer that goes untreated and leads to a rapid, painful death (our neighbor did that, not recommended).
So, insist on the PSA test, and proceed accordingly.
On another note, many general practice docs don't prep you for the PSA properly. To get a representative number, you have to avoid stimulating the prostate for three days before the blood test. That means no sex, no bicycle riding, no hard bowel movements, and no digital exam (finger up the butt). My internist used to give me the finger wave during his physical exam, and THEN send me for my blood draw. That's certain to get a high PSA result, due to the trauma to the prostate immediately before sampling. Bad doctor!
Paul, prostate cancer survivor mode