{"id":4916,"date":"2026-09-06T22:35:53","date_gmt":"2026-09-06T21:35:53","guid":{"rendered":"https:\/\/www.dumonceau-urologie.fr\/urology\/prostate-cancer-screening-psa-mri-biopsies\/"},"modified":"2026-09-06T22:58:36","modified_gmt":"2026-09-06T21:58:36","slug":"prostate-cancer-screening-psa-mri-biopsies","status":"publish","type":"post","link":"https:\/\/www.dumonceau-urologie.fr\/en\/urology\/prostate-cancer-screening-psa-mri-biopsies\/","title":{"rendered":"Prostate cancer screening: PSA, MRI, biopsies"},"content":{"rendered":"\n<div class=\"upo-article\"><p class=\"upo-article__lead\">Understanding the steps of prostate assessment, at what age to start, and how to interpret the results \u2014 <strong>PSA, multiparametric MRI, targeted biopsies<\/strong> , explained simply.<\/p><p class=\"upo-article__byline\"> <span>By <strong>Dr. Olivier Dumonceau<\/strong> , urological surgeon specializing in prostate cancer,<\/span> <span>Urology Practice Paris Op\u00e9ra \u2014 82 Bd de Courcelles, Paris 17th <sup>.<\/sup><\/span> <span>Reading time: 12 minutes<\/span> <\/p><nav class=\"upo-article__toc\" aria-label=\"Sommaire de l'article\"><p class=\"upo-article__toc-title\"> Contents<\/p><ol><li> <a href=\"#pourquoi-depister\">Why I believe in screening<\/a><\/li><li> <a href=\"#cancer-prostate-2026\">Prostate cancer today<\/a><\/li><li> <a href=\"#a-quel-age\">At what age should I start?<\/a><\/li><li> <a href=\"#bilan-diagnostique\">The assessment in four stages<\/a><\/li><li> <a href=\"#psa\">Step 1 \u2014 the PSA<\/a><\/li><li> <a href=\"#irm\">Step 2 \u2014 Multiparameter MRI<\/a><\/li><li> <a href=\"#biopsies\">Step 3 \u2014 Targeted biopsies<\/a><\/li><li> <a href=\"#rcp\">Step 4 \u2014 CPR<\/a><\/li><li> <a href=\"#si-confirme\">If the cancer is confirmed<\/a><\/li><li> <a href=\"#surveillance-active\">Active surveillance<\/a><\/li><li> <a href=\"#faq\">Your frequently asked questions<\/a><\/li><li> <a href=\"#retenir\">Key takeaways<\/a><\/li><\/ol><\/nav><h2 id=\"pourquoi-depister\"> Why I strongly believe in screening \u2014 and what I tell my patients about it<\/h2><p> There are two reasons why a man might come to my office requesting a prostate exam. The first: his primary care physician has reported a <strong>slightly elevated PSA level<\/strong> . The second: his father, brother, or a close friend has just been diagnosed with prostate cancer.<\/p><p> In both cases, my answer is the same: you did the right thing by coming, and <strong>you have time to do things properly<\/strong> . Prostate cancer is certainly the most common cancer in men in France \u2014 around 60,000 new cases per year according to the INCa \u2014 but it is also one of the cancers for which early detection makes the biggest difference.<\/p><blockquote class=\"upo-quote\"><p> Cancer detected at a localized stage has an excellent chance of success in treatment. Cancer discovered late is more complex to treat\u2014for both the patient and the doctor.<\/p> <cite>Dr. Olivier Dumonceau<\/cite><\/blockquote><h2 id=\"cancer-prostate-2026\"> What you need to know about prostate cancer<\/h2><h3> The most common cancer in men in France<\/h3><p> In France, prostate cancer is the <strong>most common cancer in men in terms of incidence<\/strong> \u2014ahead of lung and colorectal cancer. The average age at diagnosis is 70, but earlier onsets are possible, particularly in men with a family history of the disease.<\/p><ul class=\"upo-stats\"><li> <b><sup>1st<\/sup><\/b> <span>male cancer in France<\/span><\/li><li> <b>~60,000<\/b> <span>new cases per year (INCa)<\/span><\/li><li> <b>70 years<\/b> <span>average age at diagnosis<\/span><\/li><li> <b>> 95%<\/b> <span>5-year survival rate if detected at a localized stage<\/span><\/li><\/ul><p> The good news\u2014and it&#8217;s important\u2014is that the 5-year survival rate for localized cancer detected early <strong>exceeds 95%<\/strong> . This is one of the most favorable prognoses in oncology. And this excellent prognosis is directly linked to the quality of screening.<\/p><h3> A cancer that often develops silently<\/h3><p> This is what makes screening essential, and why I don&#8217;t wait for symptoms to appear before suggesting an evaluation. Prostate cancer, in its early stages, <strong>generally presents no clinical signs<\/strong> . No pain, no blood in the urine, no specific erectile dysfunction.<\/p><p> When urinary symptoms appear\u2014difficulty urinating, weak stream, frequent nighttime urges\u2014they are most often linked to <a href=\"https:\/\/www.dumonceau-urologie.fr\/en\/urology\/how-can-i-treat-my-prostate-adenoma\/\">benign prostatic hyperplasia (BPH)<\/a> , which is a benign condition. Cancer, on the other hand, is often hidden. This is why regular PSA testing remains the only reliable screening tool available to us. <\/p><figure class=\"upo-figure\"><img src=\"https:\/\/www.dumonceau-urologie.fr\/wp-content\/uploads\/2026\/08\/anatomie-de-la-prostate-schema-coupe-transversale.webp\" alt=\"Anatomical diagram in cross-section of the prostate: lateral lobes, middle lobe, urethra and ejaculatory ducts\" width=\"1200\" height=\"675\" loading=\"lazy\" decoding=\"async\"\/><figcaption> Horizontal section of the prostate. The anatomy of the gland \u2014 lateral lobes, middle lobe, prostatic urethra \u2014 explains why a tumor can grow there for a long time without causing any urinary symptoms.<\/figcaption><\/figure><h2 id=\"a-quel-age\"> At what age should we start? Who is affected?<\/h2><h3> The recommendations I apply during consultations<\/h3><p> French official recommendations\u2014issued by the <strong>High Authority for Health<\/strong> and the <strong>French Association of Urology<\/strong> \u2014have not established a universal organized screening program, unlike for breast or cervical cancer. This does not mean that screening should not be performed; it means that screening should be <strong>individualized, informed, and tailored to each patient&#8217;s profile<\/strong> .<\/p><p> Here is what I specifically recommend: a clinical examination and a PSA test every year\u2026<\/p><ul class=\"upo-checklist upo-checklist--dot\"><li> <strong>Suitable from age 50<\/strong> for any man in good general health.<\/li><li> <strong>From age 45<\/strong> in case of a first-degree family history (father, brother, son) of prostate cancer.<\/li><li> <strong>From 40\u201345 years of age<\/strong> for men of African or Afro-Caribbean origin, whose risk is statistically higher and whose forms are often more aggressive \u2014 particularly in the event of exposure to Chlordecone.<\/li><li> <strong>At any age in case of clinical suspicion<\/strong> : unexplained urinary symptoms, abnormality on rectal examination, PSA already elevated on a previous assessment.<\/li><\/ul><div class=\"upo-callout upo-callout--warn\"> <span class=\"upo-callout__title\">The most frequently misunderstood point<\/span><p> Screening does not stop at a single PSA test. It is a <strong>follow-up over time<\/strong> : the kinetics of PSA \u2014 its rate of increase \u2014 is sometimes more informative than its absolute value at a given moment.<\/p><\/div><h3> Risk factors to be aware of<\/h3><p> A man whose father had prostate cancer before the age of 65 should see a urologist as early as age 45, or even 40 if two family members are affected. This is a recommendation I strictly follow\u2014and it sometimes allows for the detection of cancer at a very early, completely curable stage. <\/p><div class=\"upo-table-wrap\"><table class=\"upo-table upo-table--stack\"><caption class=\"upo-table__caption\"> Risk factors for prostate cancer and what to do<\/caption><thead><tr><th scope=\"col\"> Risk factor<\/th><th scope=\"col\"> Impact on risk<\/th><th scope=\"col\"> What I recommend<\/th><\/tr><\/thead><tbody><tr><th scope=\"row\"> Age > 50 years<\/th><td data-label=\"Impact\"> The risk is doubled between the ages of 50 and 70.<\/td><td data-label=\"Recommandation\"> Annual screening from age 50<\/td><\/tr><tr><th scope=\"row\"> Family history (father, brother, son)<\/th><td data-label=\"Impact\"> Risk \u00d72 to \u00d73 depending on the degree<\/td><td data-label=\"Recommandation\"> Screening begins at age 45, sometimes at age 40 if there are 2 or more cases<\/td><\/tr><tr><th scope=\"row\"> African or Afro-Caribbean origin<\/th><td data-label=\"Impact\"> Risk doubled, often more aggressive forms<\/td><td data-label=\"Recommandation\"> Enhanced screening from age 45<\/td><\/tr><tr><th scope=\"row\"> BRCA1 \/ BRCA2 Mutation<\/th><td data-label=\"Impact\"> Often more aggressive forms<\/td><td data-label=\"Recommandation\"> Oncogenetic consultation + early screening<\/td><\/tr><tr><th scope=\"row\"> A rich Western diet<\/th><td data-label=\"Impact\"> A contributing factor shown by several studies<\/td><td data-label=\"Recommandation\"> Dietary advice provided during consultation<\/td><\/tr><tr><th scope=\"row\"> Obesity<\/th><td data-label=\"Impact\"> Associated with more aggressive forms<\/td><td data-label=\"Recommandation\"> Comprehensive weight management<\/td><\/tr><\/tbody><\/table><\/div><h2 id=\"bilan-diagnostique\"> The complete diagnostic assessment: the four stages<\/h2><p> Prostate cancer screening is not based on a single test. It&#8217;s a <strong>structured and progressive<\/strong> process, which doesn&#8217;t commit you to anything irreversible at each stage. I describe it to each patient as a funnel: we start broadly, and we refine it according to the results.<\/p><ol class=\"upo-steps\"><li> <strong>PSA testing:<\/strong> First marker, simple blood test.<\/li><li> <strong>Multiparametric MRI of the prostate<\/strong> if PSA is suspicious or increasing.<\/li><li> <strong>Targeted prostate biopsies are<\/strong> only performed if the MRI shows an abnormality.<\/li><li> <strong>The Multidisciplinary Consultation Meeting (MCM)<\/strong> To validate the diagnosis and discuss treatment options.<\/li><\/ol><h3 id=\"psa\"> Step 1: PSA \u2014 the marker you need to understand so you don&#8217;t fear it <\/h3><figure class=\"upo-figure\"><img src=\"https:\/\/www.dumonceau-urologie.fr\/wp-content\/uploads\/2026\/08\/dosage-psa-prise-de-sang-depistage-prostate.webp\" alt=\"Blood collection tubes in the analysis laboratory for PSA testing\" width=\"1200\" height=\"675\" loading=\"lazy\" decoding=\"async\"\/><figcaption> PSA testing is done with a simple blood test, without any special preparation. It&#8217;s the starting point for a prostate assessment \u2014 not a diagnosis.<\/figcaption><\/figure><p> <strong>PSA (Prostate-Specific Antigen)<\/strong> is a protein produced by prostate cells. Measuring its level in the blood is the primary screening tool. But it is also the most misunderstood\u2014and most misinterpreted\u2014test.<\/p><div class=\"upo-callout upo-callout--key\"> <span class=\"upo-callout__title\">Absolutely essential to remember<\/span><p> <strong>PSA \u2260 cancer.<\/strong> It is a marker of the prostate, not of cancer. It can be elevated for many reasons: urinary tract infection, inflammation of the prostate (prostatitis), benign prostatic hyperplasia (BPH), recent intense physical exertion\u2026 or cancer.<\/p><p> <strong>High PSA \u2260 cancer. Normal PSA \u2260 absence of cancer.<\/strong> A high PSA alone is never a death sentence: it&#8217;s a signal that calls for further investigation. <\/p><\/div><div class=\"upo-table-wrap\"><table class=\"upo-table upo-table--stack\"><caption class=\"upo-table__caption\"> Interpretation of the PSA and the appropriate course of action<\/caption><thead><tr><th scope=\"col\"> PSA Value<\/th><th scope=\"col\"> Usual interpretation<\/th><th scope=\"col\"> What I do<\/th><th scope=\"col\"> Monitoring frequency<\/th><\/tr><\/thead><tbody><tr><th scope=\"row\"> < 1 ng\/mL<\/th><td data-label=\"Interpr\u00e9tation\"> Very reassuring before age 60<\/td><td data-label=\"Ce que je fais\"> Spaced PSA testing<\/td><td data-label=\"Suivi\"> Every 2 years<\/td><\/tr><tr><th scope=\"row\"> 1 \u2013 2 ng\/mL<\/th><td data-label=\"Interpr\u00e9tation\"> Normal \u2014 vigilance if rapid progression<\/td><td data-label=\"Ce que je fais\"> PSA test + clinical examination<\/td><td data-label=\"Suivi\"> Annual<\/td><\/tr><tr><th scope=\"row\"> 2 \u2013 4 ng\/mL<\/th><td data-label=\"Interpr\u00e9tation\"> Intermediate zone \u2014 enhanced surveillance<\/td><td data-label=\"Ce que je fais\"> Annual PSA test, MRI recommended if rapid rise in PSA is expected; MRI should be considered if rapid increase is present.<\/td><td data-label=\"Suivi\"> Annual approach<\/td><\/tr><tr><th scope=\"row\"> 4 \u2013 10 ng\/mL<\/th><td data-label=\"Interpr\u00e9tation\"> Suspicious area \u2014 additional assessment<\/td><td data-label=\"Ce que je fais\"> Multiparametric MRI as a first-line treatment<\/td><td data-label=\"Suivi\"> According to MRI results<\/td><\/tr><tr><th scope=\"row\"> > 10 ng\/mL<\/th><td data-label=\"Interpr\u00e9tation\"> Highly suspicious \u2014 assessment not to be delayed<\/td><td data-label=\"Ce que je fais\"> MRI and targeted biopsies likely<\/td><td data-label=\"Suivi\"> Quick consultation<\/td><\/tr><tr><th scope=\"row\"> Doubling speed (< 2 years)<\/th><td data-label=\"Interpr\u00e9tation\"> Worrying kinetics regardless of the value<\/td><td data-label=\"Ce que je fais\"> MRI \u00b1 biopsies depending on the context<\/td><td data-label=\"Suivi\"> Urgent consultation<\/td><\/tr><\/tbody><\/table><\/div><p class=\"upo-table-note\"> These values are indicative. PSA interpretation must always take into account age, prostate volume, and kinetics. This is what I do during every consultation.<\/p><div class=\"upo-callout upo-callout--info\"> <span class=\"upo-callout__title\">Good to know<\/span><p> <strong>PSA density<\/strong> \u2014the ratio of PSA levels to prostate volume measured by MRI\u2014is a more reliable indicator than the raw value. A PSA of 6 in an 80 cc prostate is less concerning than a PSA of 6 in a 25 cc prostate.<\/p><\/div><h3 id=\"irm\"> Step 2: Multiparametric MRI \u2014 the diagnostic revolution <\/h3><figure class=\"upo-figure\"><img src=\"https:\/\/www.dumonceau-urologie.fr\/wp-content\/uploads\/2026\/08\/irm-multiparametrique-prostate-examen-diagnostic.webp\" alt=\"Modern MRI room in a diagnostic center, magnetic resonance imaging machine\" width=\"1200\" height=\"675\" loading=\"lazy\" decoding=\"async\"\/><figcaption> Multiparametric MRI has become the standard examination before any biopsy. Non-invasive and non-irradiating, it lasts 30 to 45 minutes.<\/figcaption><\/figure><p> Before its development, a biopsy was routinely performed whenever the PSA level exceeded a certain threshold. Today, <a href=\"https:\/\/www.dumonceau-urologie.fr\/en\/urology\/prostate-mri-what-is-its-purpose-and-which-patients-is-this-examination-suitable-for\/\">prostate MRI<\/a> allows for precise visualization of the gland\u2014its volume, structure, the possible presence of a suspicious lesion, and its exact location.<\/p><p> This examination uses the <strong>PI-RADS score<\/strong> , an international classification from 1 to 5, to grade the degree of suspicion of each identified lesion:<\/p><ul class=\"upo-checklist upo-checklist--dot\"><li> <strong>PI-RADS 1\u20132<\/strong> \u2014 very unlikely to be significant cancer: biopsy often not necessary.<\/li><li> <strong>PI-RADS 3<\/strong> \u2014 interim result: biopsy decision discussed on a case-by-case basis.<\/li><li> <strong>PI-RADS 4\u20135<\/strong> \u2014 suspicious lesion: targeted biopsy recommended.<\/li><\/ul><div class=\"upo-callout upo-callout--good\"> <span class=\"upo-callout__title\">A major step forward for patients<\/span><p> MRI has <strong>significantly reduced the number of unnecessary biopsies<\/strong> and increased the detection rate of clinically significant cancers by targeting specific areas for biopsy. Fewer invasive procedures, greater diagnostic accuracy.<\/p><\/div><h3 id=\"biopsies\"> Step 3: Targeted prostate biopsies<\/h3><p> If MRI identifies a suspicious lesion (PI-RADS 4 or 5), <strong>targeted prostate biopsy<\/strong> is recommended: MRI-guided sampling of only the suspicious areas.<\/p><p> This technique is radically different from the systematic &quot;sexting&quot; biopsies of fifteen years ago, which randomly sampled tissue from across the entire prostate. Today, the samples are targeted\u2014fewer in number, but far more relevant.<\/p><p> The procedure is performed under local or general anesthesia on an outpatient basis. Antibiotics are prescribed as a preventative measure. Histological results\u2014including the <strong>Gleason score\/ISUP grade<\/strong> \u2014are generally available 7 to 10 days later.<\/p><ul class=\"upo-facts\"><li> <span class=\"upo-facts__value\">Trans-perineal<\/span> <span class=\"upo-facts__label\">technique<\/span><\/li><li> <span class=\"upo-facts__label\">Duration:<\/span> <span class=\"upo-facts__value\">20 to 30 minutes<\/span><\/li><li> <span class=\"upo-facts__value\">Local or general<\/span> <span class=\"upo-facts__label\">anesthesia<\/span><\/li><li> <span class=\"upo-facts__label\">Hospitalization:<\/span> <span class=\"upo-facts__value\">None (outpatient)<\/span><\/li><li> <span class=\"upo-facts__label\">Results<\/span> <span class=\"upo-facts__value\">in 7 to 10 days<\/span><\/li><\/ul><div class=\"upo-callout upo-callout--info\"> <span class=\"upo-callout__title\">Why the trans-perineal route?<\/span><p> The transrectal approach has been abandoned due to the risk of infection. The transperineal approach, which I use, has significantly reduced the frequency of serious infectious complications.<\/p><\/div><h3 id=\"rcp\"> Step 4: The Multidisciplinary Consultation Meeting (RCP)<\/h3><p> Every diagnosis of prostate cancer is systematically presented and discussed in a <strong>Multidisciplinary Tumor Board meeting<\/strong> . This is a medical and ethical obligation \u2014 and a guarantee for the patient.<\/p><p> The multidisciplinary tumor board (MTB) brings together urologists, oncologists, radiation oncologists, radiologists, and pathologists. Its objective is to validate the diagnosis, analyze all relevant factors (clinical stage, Gleason score, PSA, MRI), and collaboratively propose appropriate treatment options.<\/p><blockquote class=\"upo-quote\"><p> The result of the multidisciplinary team meeting does not impose anything on you. It is an informed, multidisciplinary recommendation \u2014 on the basis of which you will make your decision with me during a dedicated consultation.<\/p> <cite>Dr. Olivier Dumonceau<\/cite><\/blockquote><h2 id=\"si-confirme\"> If cancer is confirmed: what happens next?<\/h2><p> A prostate cancer diagnosis is always a difficult time. I know this, and I try to make it as clear and reassuring as possible. Here&#8217;s what I always explain to my patients after the diagnosis is confirmed.<\/p><h3> The assessment of the extent of the disease: verifying that it is localized.<\/h3><p> Before deciding on a treatment, it is verified that the cancer is confined to the prostate or its immediate surroundings. This staging workup generally includes:<\/p><ul class=\"upo-checklist upo-checklist--dot\"><li> <strong>A pelvic MRI<\/strong> \u2014 usually already performed during the initial assessment.<\/li><li> <strong>A PSMA PET scan<\/strong> \u2014 for cases of intermediate-high or high risk, to detect possible metastases. It now replaces thoraco-abdomino-pelvic CT scans and bone scintigraphy.<\/li><\/ul><p> In the vast majority of cases diagnosed today\u2014thanks to early detection\u2014 <strong>the disease is localized to the prostate<\/strong> . This opens up all curative treatment options.<\/p><h3> Treatment options according to profile<\/h3><p> Once a complete diagnosis has been made and discussed in a multidisciplinary team meeting, several options are available depending on the stage of the disease, the Gleason score, the PSA level, and your overall profile: <\/p><div class=\"upo-table-wrap\"><table class=\"upo-table upo-table--stack\"><caption class=\"upo-table__caption\"> Treatment options for prostate cancer<\/caption><thead><tr><th scope=\"col\"> Option<\/th><th scope=\"col\"> For which profile?<\/th><th scope=\"col\"> Main advantage<\/th><th scope=\"col\"> Main constraint<\/th><th scope=\"col\"> PSA tracking<\/th><\/tr><\/thead><tbody><tr><th scope=\"row\"> Active surveillance<\/th><td data-label=\"Profil\"> Very low-risk cancer, age < 70 years<\/td><td data-label=\"Avantage\"> No immediate treatment, quality of life preserved<\/td><td data-label=\"Contrainte\"> Repeated biopsies, possible anxiety<\/td><td data-label=\"Suivi\"> PSA + periodic biopsies<\/td><\/tr><tr><th scope=\"row\"> Robotic prostatectomy<\/th><td data-label=\"Profil\"> Intermediate to high risk, age < 75 years<\/td><td data-label=\"Avantage\"> Complete histological analysis, possible salvage by radiotherapy<\/td><td data-label=\"Contrainte\"> Risks of incontinence and erectile dysfunction are rare and usually transient.<\/td><td data-label=\"Suivi\"> PSA for life (undetectable target)<\/td><\/tr><tr><th scope=\"row\"> External beam radiotherapy<\/th><td data-label=\"Profil\"> Intermediate to high risk, age < 75 years<\/td><td data-label=\"Avantage\"> Non-invasive, no anesthesia<\/td><td data-label=\"Contrainte\"> 30 to 40 sessions; no surgical intervention; post-radiation cystitis\/rectitis<\/td><td data-label=\"Suivi\"> Lifetime PSA (nadir + 2)<\/td><\/tr><tr><th scope=\"row\"> Brachytherapy<\/th><td data-label=\"Profil\"> Low risk, prostate < 50 cc<\/td><td data-label=\"Avantage\"> Single session, good results<\/td><td data-label=\"Contrainte\"> Frequent urinary side effects<\/td><td data-label=\"Suivi\"> Annual PSA<\/td><\/tr><tr><th scope=\"row\"> High-intensity focused ultrafiltration (HIFU)<\/th><td data-label=\"Profil\"> Focal tumor clearly identified<\/td><td data-label=\"Avantage\"> Conservative, few side effects<\/td><td data-label=\"Contrainte\"> Strict selection, less hindsight<\/td><td data-label=\"Suivi\"> PSA + follow-up MRI<\/td><\/tr><tr><th scope=\"row\"> Hormone therapy \u00b1 radiotherapy<\/th><td data-label=\"Profil\"> Locally advanced or metastatic cancer<\/td><td data-label=\"Avantage\"> Effective systemic treatment<\/td><td data-label=\"Contrainte\"> Pronounced endocrine effects<\/td><td data-label=\"Suivi\"> PSA + bone health assessment<\/td><\/tr><\/tbody><\/table><\/div><p> I dedicate the necessary time to explaining each option during consultations. There is no universally right or wrong decision: there is <strong>only the decision that is right for your cancer, your life, and your values<\/strong> . To learn more, you can visit my page dedicated to <a href=\"https:\/\/www.dumonceau-urologie.fr\/en\/urologue-expertise\/robotic-assisted-radical-prostatectomy\/\">robot-assisted radical prostatectomy<\/a> .<\/p><h2 id=\"surveillance-active\"> Active monitoring: do not treat when it is not necessary<\/h2><p> This is a point I want to focus on \u2014 because it&#8217;s an option that is often underestimated, and one that I apply regularly.<\/p><div class=\"upo-callout upo-callout--key\"><p> Diagnosing prostate cancer is important: <strong>there is no such thing as overdiagnosis<\/strong> . On the other hand, <strong>overtreatment<\/strong> must be avoided.<\/p><\/div><p> For very low-risk cancers\u2014Gleason 6 \/ ISUP 1, PSA < 10, clinical stage T1c-T2a\u2014active surveillance is a medically valid and recommended option. It involves not treating immediately, but rigorously monitoring the progression of the disease with regular PSA testing, MRI, and follow-up biopsies.<\/p><p> Several large-scale studies \u2014 notably <strong>ProtecT<\/strong> and <strong>PIVOT<\/strong> \u2014 have shown that for these low-grade cancers, specific mortality is the same whether the patient is treated immediately or placed under active surveillance, over 10 to 15 years of follow-up.<\/p><blockquote class=\"upo-quote\"><p> A low-grade prostate cancer, when closely monitored, can remain stable for years without ever requiring treatment. When the indication is appropriate, avoiding surgery and radiation is a form of treatment.<\/p> <cite>Dr. Olivier Dumonceau<\/cite><\/blockquote><p> Active monitoring is not abandonment. It is an <strong>informed choice that preserves quality of life<\/strong> \u2014 and can be reassessed at any time if the disease progresses.<\/p><h2 id=\"faq\"> FAQ: Your questions about prostate screening<\/h2><div class=\"upo-faq\"><details class=\"upo-faq__item\"><summary> At what age should I get tested?<\/summary><div class=\"upo-faq__answer\"><p> Starting at age 50 for men without any particular risk factors, with an annual PSA test. Starting at age 45 if you have a family history (father, brother) of prostate cancer. Starting at age 40\u201345 if you are of African or Afro-Caribbean descent. And at any age if your doctor reports an abnormality. These recommendations are individualized: what applies to your neighbor may not apply to you.<\/p><\/div><\/details><details class=\"upo-faq__item\"><summary> My PSA is slightly elevated \u2014 should I be worried?<\/summary><div class=\"upo-faq__answer\"><p> Not necessarily. A high PSA level doesn&#8217;t automatically mean cancer. It can be elevated in cases of benign prostatic hyperplasia (BPH), urinary tract infection, prostatitis, or even after intense physical exertion. What interests me most is the kinetics\u2014the evolution of PSA over time\u2014and its density relative to the prostate volume. A slightly elevated PSA level warrants a urological consultation, not panic.<\/p><\/div><\/details><details class=\"upo-faq__item\"><summary> Is an MRI mandatory if the PSA level is high?<\/summary><div class=\"upo-faq__answer\"><p> No\u2014but I highly recommend it before any biopsy. Multiparametric MRI has become the gold standard examination before biopsy according to European guidelines (EAU 2024). It allows for the precise identification of suspicious areas, avoids many unnecessary biopsies, and allows for targeted sampling if a lesion is present. It is more precise, less invasive, and more comfortable for the patient.<\/p><\/div><\/details><details class=\"upo-faq__item\"><summary> Are prostate biopsies painful?<\/summary><div class=\"upo-faq__answer\"><p> MRI-guided fusion biopsies are performed under local or general anesthesia. Discomfort is usually minimal. Transient side effects are possible in the following days: traces of blood in the urine, stool, or semen (normal and temporary), and a slight fever in the first 24 hours. I prescribe antibiotics as a preventative measure. In our practice, serious complications are rare, especially since the introduction of transperineal biopsies, rather than transrectal ones.<\/p><\/div><\/details><details class=\"upo-faq__item\"><summary> Is it possible to have prostate cancer without urinary symptoms?<\/summary><div class=\"upo-faq__answer\"><p> Yes\u2014and that&#8217;s precisely why screening is essential. In its early stages, prostate cancer generally presents no symptoms. Urinary problems\u2014weak stream, frequent urges, leakage\u2014are most often related to benign prostatic hyperplasia (BPH), not cancer. Waiting for symptoms to appear before seeking medical help risks a late diagnosis. That&#8217;s why I recommend annual PSA testing starting at age 50, even in perfect health.<\/p><\/div><\/details><details class=\"upo-faq__item\"><summary> What is active surveillance \u2014 and is it really safe?<\/summary><div class=\"upo-faq__answer\"><p> Active surveillance involves not immediately treating a very low-risk cancer, but rather monitoring it rigorously: regular PSA tests, follow-up MRIs, and periodic biopsies. Large studies (ProtecT, PIVOT) have shown that for low-grade cancers, this approach does not compromise 10- to 15-year survival. It is a treatment option that I regularly recommend\u2014and one that I often consider preferable to immediate treatment for certain patient profiles.<\/p><\/div><\/details><details class=\"upo-faq__item\"><summary> Is prostate cancer screening covered by insurance?<\/summary><div class=\"upo-faq__answer\"><p> PSA testing is covered by French National Health Insurance (Assurance Maladie) with a doctor&#8217;s prescription. Prostate MRI is also covered as part of the coordinated care pathway. Fusion biopsies are reimbursed in healthcare facilities according to the current fee schedule. Your out-of-pocket expenses will depend on your supplemental health insurance. I will explain the details during your consultation.<\/p><\/div><\/details><details class=\"upo-faq__item\"><summary> Can I get a second opinion before deciding on a treatment?<\/summary><div class=\"upo-faq__answer\"><p> Absolutely\u2014and I encourage it. Taking the time for a second opinion is a wise and legitimate step when faced with such an important diagnosis. I regularly see patients who come seeking a second opinion after consulting another specialist. What I offer is a thorough review of the entire medical file, a transparent discussion of the options, and the outcome of a multidisciplinary consultation if necessary.<\/p><\/div><\/details><details class=\"upo-faq__item\"><summary> My father had prostate cancer \u2014 am I necessarily going to get it?<\/summary><div class=\"upo-faq__answer\"><p> No\u2014a family history increases the risk, but it&#8217;s not a death sentence. It justifies earlier (starting at age 45) and more frequent screening. In some cases where several family members are affected, or if a genetic mutation (BRCA2) is suspected, a consultation with an oncogeneticist may be helpful. But the vast majority of men with a family history of prostate cancer will not develop it\u2014especially if screening is followed properly.<\/p><\/div><\/details><\/div><h2 id=\"retenir\"> Key takeaways <\/h2><figure class=\"upo-figure\"><img src=\"https:\/\/www.dumonceau-urologie.fr\/wp-content\/uploads\/2026\/08\/dr-olivier-dumonceau-urologue-consultation-paris-17.webp\" alt=\"Dr. Olivier Dumonceau, a urological surgeon in the 17th arrondissement of Paris, during a consultation at his office\" width=\"1200\" height=\"675\" loading=\"lazy\" decoding=\"async\"\/><figcaption> Dr Olivier Dumonceau \u2014 Urology Practice Paris Op\u00e9ra, 82 Bd de Courcelles, Paris 17th <sup>arrondissement<\/sup> .<\/figcaption><\/figure><div class=\"upo-takeaway\"><p class=\"upo-takeaway__title\"> The essentials in five points<\/p><ul><li> Prostate cancer is common \u2014 but it is also one of the cancers that is most treatable <strong>when detected early<\/strong> .<\/li><li> Regular PSA testing <strong>from age 50<\/strong> \u2014 or 45 in the case of risk factors \u2014 is a simple, quick and potentially decisive step.<\/li><li> The assessment is a progressive process: PSA testing, then MRI, then targeted biopsies only if necessary. <strong>Nothing is irreversible at each stage.<\/strong><\/li><li> In most cases, the assessment is reassuring. But when it is not, <strong>early diagnosis changes everything<\/strong> .<\/li><li> The goal of screening is simple: <strong>to give you time to understand, decide and choose the right treatment<\/strong> .<\/li><\/ul><\/div><p> My role is not to alarm you. My role is to support you, with the right tests, at the right time. <strong>The best time to have a prostate exam is before you have any reason to worry. Not after.<\/strong><\/p><div class=\"upo-cta\"><p class=\"upo-cta__title\"> Assess your prostate<\/p><p> If you recognize yourself in this situation, let&#8217;s take the time to discuss it together in a consultation.<\/p><p class=\"upo-cta__actions\"> <a class=\"upo-cta__btn\" href=\"https:\/\/www.doctolib.fr\/chirurgien-urologue\/paris\/olivier-dumonceau\/booking\/telehealth-suggestion\" target=\"_blank\" rel=\"noopener\">Make an appointment<\/a> <a class=\"upo-cta__btn upo-cta__btn--ghost\" href=\"https:\/\/www.dumonceau-urologie.fr\/en\/besoins-urologie\/early-detection-of-prostate-cancer\/\">Screening in practice<\/a><\/p><p class=\"upo-cta__contact\"> <span><a href=\"tel:+33142688330\">01 42 68 83 30<\/a><\/span> <span>82 Bd de Courcelles, Paris <sup>17th<\/sup><\/span> <span><a href=\"mailto:contact@dumonceau-urologie.fr\">contact@dumonceau-urologie.fr<\/a><\/span><\/p><\/div><aside class=\"upo-sources\"><p class=\"upo-sources__title\"> Medical sources and references<\/p><ul><li> EAU Guidelines on Prostate Cancer 2024 \u2014 European Association of Urology.<\/li><li> French National Authority for Health (HAS) \u2014 Early detection of prostate cancer, 2021.<\/li><li> INCa \u2014 Epidemiological data on prostate cancer, France, 2023.<\/li><li> Hamdy FC et al. \u2014 <em>15-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer<\/em> (ProtecT trial). NEJM, 2023.<\/li><li> Kasivisvanathan V et al. \u2014 <em>MRI-Targeted or Standard Biopsy for Prostate Cancer Diagnosis<\/em> (ACCURATE). NEJM, 2018.<\/li><li> French Society of Urology (SFU) \u2014 Recommendations for good practices, prostate cancer.<\/li><\/ul><p class=\"upo-disclaimer\"> This article is for informational purposes only and does not replace a medical consultation. Only a clinical examination and personalized assessment can establish a diagnosis and propose a treatment plan tailored to your situation.<\/p><\/aside><\/div> <script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"FAQPage\",\"mainEntity\":[{\"@type\":\"Question\",\"name\":\"\u00c0 partir de quel \u00e2ge dois-je me faire d\u00e9pister ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"\u00c0 partir de 50 ans pour un homme sans facteur de risque particulier, avec un dosage de PSA annuel. \u00c0 partir de 45 ans si vous avez un ant\u00e9c\u00e9dent familial (p\u00e8re, fr\u00e8re) de cancer de la prostate. \u00c0 partir de 40\u201345 ans si vous \u00eates d'origine africaine ou afro-carib\u00e9enne. Et \u00e0 tout \u00e2ge si votre m\u00e9decin traitant signale une anomalie. Ces recommandations sont individualis\u00e9es : ce qui est valable pour votre voisin ne l'est pas forc\u00e9ment pour vous.\"}},{\"@type\":\"Question\",\"name\":\"Mon PSA est l\u00e9g\u00e8rement \u00e9lev\u00e9 \u2014 dois-je m'inqui\u00e9ter ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Pas n\u00e9cessairement. Un PSA \u00e9lev\u00e9 n'est pas synonyme de cancer. Il peut l'\u00eatre en cas d'ad\u00e9nome b\u00e9nin (HBP), d'infection urinaire, de prostatite, ou m\u00eame apr\u00e8s un effort physique intense. Ce qui m'int\u00e9resse le plus, c'est la cin\u00e9tique \u2014 l'\u00e9volution du PSA dans le temps \u2014 et sa densit\u00e9 par rapport au volume prostatique. Un PSA l\u00e9g\u00e8rement \u00e9lev\u00e9 m\u00e9rite une consultation d'urologie, pas une panique.\"}},{\"@type\":\"Question\",\"name\":\"L'IRM est-elle obligatoire si le PSA est \u00e9lev\u00e9 ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Non \u2014 mais je la recommande fortement avant toute biopsie. L'IRM multiparam\u00e9trique est devenue l'examen de r\u00e9f\u00e9rence avant biopsie selon les recommandations europ\u00e9ennes (EAU 2024). Elle permet d'identifier pr\u00e9cis\u00e9ment les zones suspectes, d'\u00e9viter de nombreuses biopsies inutiles, et de cibler les pr\u00e9l\u00e8vements si une l\u00e9sion est pr\u00e9sente. C'est plus pr\u00e9cis, moins invasif, et plus confortable pour le patient.\"}},{\"@type\":\"Question\",\"name\":\"Les biopsies prostatiques sont-elles douloureuses ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Les biopsies de fusion guid\u00e9es par IRM sont r\u00e9alis\u00e9es sous anesth\u00e9sie locale ou g\u00e9n\u00e9rale. L'inconfort est g\u00e9n\u00e9ralement faible. Des effets secondaires transitoires sont possibles dans les jours suivants : traces de sang dans les urines, les selles ou le sperme (normales et temporaires), l\u00e9g\u00e8re fi\u00e8vre dans les premi\u00e8res 24 heures. Je prescris des antibiotiques en pr\u00e9vention. Dans notre pratique, les complications graves sont rares, surtout depuis l'arriv\u00e9e des biopsies par voie trans-p\u00e9rin\u00e9ale et non plus trans-rectale.\"}},{\"@type\":\"Question\",\"name\":\"Peut-on avoir un cancer de la prostate sans sympt\u00f4mes urinaires ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Oui \u2014 et c'est pr\u00e9cis\u00e9ment pour cela que le d\u00e9pistage est indispensable. Aux stades pr\u00e9coces, le cancer de la prostate ne donne en g\u00e9n\u00e9ral aucun sympt\u00f4me. Les troubles urinaires \u2014 jet faible, envies fr\u00e9quentes, fuites \u2014 sont le plus souvent li\u00e9s \u00e0 l'ad\u00e9nome b\u00e9nin (HBP), pas au cancer. Attendre les sympt\u00f4mes pour consulter, c'est risquer un diagnostic tardif. C'est pour cela que je recommande un suivi PSA annuel d\u00e8s 50 ans, m\u00eame en parfaite sant\u00e9.\"}},{\"@type\":\"Question\",\"name\":\"Qu'est-ce que la surveillance active \u2014 et est-ce vraiment s\u00fbr ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"La surveillance active consiste \u00e0 ne pas traiter imm\u00e9diatement un cancer \u00e0 tr\u00e8s faible risque, mais \u00e0 le surveiller rigoureusement : PSA r\u00e9gulier, IRM de contr\u00f4le et biopsies p\u00e9riodiques. De grandes \u00e9tudes (ProtecT, PIVOT) ont montr\u00e9 que pour les cancers peu agressifs, cette approche ne compromet pas la survie sur 10 \u00e0 15 ans. C'est une option \u00ab de traitement \u00bb que je propose r\u00e9guli\u00e8rement \u2014 et que je consid\u00e8re souvent pr\u00e9f\u00e9rable au traitement imm\u00e9diat pour certains profils.\"}},{\"@type\":\"Question\",\"name\":\"Est-ce que le d\u00e9pistage du cancer de la prostate est rembours\u00e9 ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Le dosage du PSA est rembours\u00e9 par l'Assurance Maladie sur prescription m\u00e9dicale. L'IRM prostatique est \u00e9galement prise en charge dans le cadre du parcours de soins. Les biopsies de fusion sont rembours\u00e9es en \u00e9tablissement de sant\u00e9 selon la nomenclature en vigueur. Le reste \u00e0 charge d\u00e9pend de votre mutuelle. Je d\u00e9taille les modalit\u00e9s lors de la consultation.\"}},{\"@type\":\"Question\",\"name\":\"Puis-je avoir un deuxi\u00e8me avis avant de d\u00e9cider d'un traitement ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Absolument \u2014 et je l'encourage. Prendre le temps d'un deuxi\u00e8me avis est une d\u00e9marche sage et l\u00e9gitime face \u00e0 un diagnostic aussi important. Je re\u00e7ois r\u00e9guli\u00e8rement des patients qui viennent chercher un avis compl\u00e9mentaire apr\u00e8s avoir vu un autre sp\u00e9cialiste. Ce que j'apporte : une lecture rigoureuse de l'ensemble du dossier, une discussion transparente des options, et le r\u00e9sultat d'une concertation pluridisciplinaire si n\u00e9cessaire.\"}},{\"@type\":\"Question\",\"name\":\"Mon p\u00e8re a eu un cancer de la prostate \u2014 vais-je forc\u00e9ment en avoir un ?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Non \u2014 un ant\u00e9c\u00e9dent familial augmente le risque, mais ne condamne pas. Il justifie un d\u00e9pistage plus pr\u00e9coce (d\u00e8s 45 ans) et plus r\u00e9gulier. Dans certains cas o\u00f9 plusieurs membres de la famille sont touch\u00e9s, ou si une mutation g\u00e9n\u00e9tique (BRCA2) est suspect\u00e9e, une consultation en oncog\u00e9n\u00e9tique peut \u00eatre utile. Mais la grande majorit\u00e9 des hommes avec un ant\u00e9c\u00e9dent familial de cancer de la prostate n'en d\u00e9velopperont pas \u2014 d'autant plus si le d\u00e9pistage est bien suivi.\"}}]}<\/script>\n","protected":false},"excerpt":{"rendered":"<p>At what age to start, how to interpret a high PSA, when to have an MRI or biopsies: prostate assessment explained step by step by Dr. Olivier Dumonceau, urological surgeon in Paris 17th.<\/p>\n","protected":false},"author":1,"featured_media":4846,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[42],"tags":[39,34],"class_list":["post-4916","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-urology","tag-mri","tag-urology"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.dumonceau-urologie.fr\/en\/wp-json\/wp\/v2\/posts\/4916","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.dumonceau-urologie.fr\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.dumonceau-urologie.fr\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.dumonceau-urologie.fr\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.dumonceau-urologie.fr\/en\/wp-json\/wp\/v2\/comments?post=4916"}],"version-history":[{"count":1,"href":"https:\/\/www.dumonceau-urologie.fr\/en\/wp-json\/wp\/v2\/posts\/4916\/revisions"}],"predecessor-version":[{"id":4917,"href":"https:\/\/www.dumonceau-urologie.fr\/en\/wp-json\/wp\/v2\/posts\/4916\/revisions\/4917"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.dumonceau-urologie.fr\/en\/wp-json\/wp\/v2\/media\/4846"}],"wp:attachment":[{"href":"https:\/\/www.dumonceau-urologie.fr\/en\/wp-json\/wp\/v2\/media?parent=4916"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.dumonceau-urologie.fr\/en\/wp-json\/wp\/v2\/categories?post=4916"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.dumonceau-urologie.fr\/en\/wp-json\/wp\/v2\/tags?post=4916"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}