Prostate Cancer Advice for Every Man, With Jonathan Shoag, M.D.
Discover how to take charge of your prostate health with practical, expert advice from Jonathan Shoag, M.D.
By
Lana Pine
| Published on October 6, 2025
6 min read
Jonathan Shoag, M.D.
Credit: Case Western Reserve University

Prostate cancer is one of the most common cancers among men, but with early screening and the right information, it’s also one of the most treatable. The Educated Patient spoke with Jonathan Shoag, M.D., urologist and associate professor at Case Western Reserve University, about the latest in prostate cancer screening, what symptoms to watch for and how men can take charge of their prostate health.
What drew you to focus your career on prostate cancer?
Jonathan Shoag, M.D.: As a urologist, prostate cancer is one of the few diseases in our field that really intersects with public health — it affects nearly every family in some way. Every man will eventually face decisions about screening, and many will experience a diagnosis personally or through loved ones. It’s a disease that combines cutting-edge molecular medicine with broad population impact, which makes it both fascinating and meaningful to study and treat.
At what age should men start thinking seriously about prostate cancer screening?
JS: For most men at average risk, screening should start around age 45. For those at higher risk—such as Black men or men with a family history of prostate cancer — it’s better to start at 40. The main screening tool is a PSA [prostate-specific antigen] blood test, which is simple and can be done during a routine physical. Although PSA screening was controversial in the past, research has improved and national guidelines are moving back toward recommending it.
Is prostate cancer screening something most primary care doctors will automatically order?
JS: Unfortunately, not always. Screening practices vary widely. In the 1990s and early 2000s, it was common, but that dropped off after 2012 when guidelines became more conservative. Now, the trend is swinging back toward more screening. The key is to have a conversation with your doctor. Even if you don’t get screened every year, it’s important to know your baseline PSA and talk about how often it should be checked based on your results and risk factors.
What symptoms might indicate that someone should ask for a PSA test?
JS: The tricky thing is that early-stage prostate cancer usually doesn’t cause symptoms. That’s why screening is so important — it can detect cancer five to seven years before symptoms appear. Some men develop urinary symptoms as they age, but those are often due to benign prostate enlargement, not cancer. Screening should happen regardless of symptoms, especially for men with higher risk factors like family history, BRCA gene mutations, or Black race.
How common is prostate cancer overall?
JS: Extremely common. About 300,000 men in the U.S. are diagnosed each year, and around 30,000 die from it. It’s the most frequently diagnosed cancer in men (after skin cancers) and the second leading cause of cancer death. The good news is that most cases are found early, and many can be managed successfully or even watched safely without immediate treatment.
If someone receives a prostate cancer diagnosis, what are the first steps they should take?
JS: First, don’t panic. Prostate cancer is often a slow-growing disease, and many men live long, healthy lives with it. The first step is to determine how aggressive it is. We look at the Gleason score (or grade group), PSA level and stage — often using MRI or specialized scans to see if it has spread.
Depending on these factors, patients may be candidates for:
- Active surveillance: Regular monitoring for early, low-risk cancers.
- Watchful waiting: Observation without treatment, usually for older men with other health issues.
- Treatment: Surgery or radiation for higher-risk cancers.
If a PSA test comes back elevated, what happens next?
JS: We’ll first confirm it with another PSA test, since levels can fluctuate. If it remains high, the next step is often a prostate MRI, which helps assess the prostate’s size and look for suspicious areas. If something concerning appears, we’ll proceed to a prostate biopsy, which gives a definitive diagnosis. The biopsy is now much safer and more comfortable than it used to be — many are done under anesthesia with minimal infection risk.
Are there any known causes or lifestyle factors that increase the risk of prostate cancer?
JS: We don’t yet have proven ways to prevent prostate cancer. Some drugs and supplements have been studied, but the data aren’t strong enough to recommend them. A healthy lifestyle — good diet, exercise, not smoking — is always important, but unfortunately, it doesn’t seem to dramatically change prostate cancer risk. The biggest risk factors remain age, genetics and race.
Many men are using testosterone replacement therapy. Is there a connection between testosterone and prostate cancer?
JS: That’s a great question. Historically, doctors thought testosterone replacement could fuel prostate cancer, but newer research shows it likely does not increase risk. Men with low testosterone can safely receive replacement therapy in most cases. It’s a shift from older thinking and an area still being studied, but current data are reassuring.
Finally, for men who want to be proactive about their prostate health, where should they start?
JS: The most important step is to talk to your primary care doctor about getting a PSA test and understanding your personal risk. Stay active, eat well and don’t ignore screening just because you feel fine. Early detection saves lives. Trusted resources like the American Urological Association and ZERO Prostate Cancer also offer great patient-friendly information.
This interview was edited for clarity.