Men
Prostate Health as You Age
Enlargement and cancer are different prostate problems. PSA screening involves benefits and harms; major supplement trials found no benefit, and one found harm.
Most men don’t think about the prostate until something sends them there: an extra trip to the bathroom at night, or a prostate-specific antigen (PSA) number on a blood-test report. PSA is a protein made by the prostate; its blood level helps guide evaluation but does not diagnose cancer by itself. The supplement aisle has plenty to say about it. So do the screening guidelines, which don’t entirely agree with each other. Humanic Blue keeps enlargement, cancer and screening separate: they’re related topics, not the same problem.
Prostate health as you age mostly involves two conditions. An enlarged prostate affects about a third of men 65 and older, according to the National Institutes of Health, and mainly causes urinary symptoms. Prostate cancer varies: in a UK trial of men with cancer found by PSA testing before it had spread, about 3% died of it over 15 years across monitoring, surgery and radiation groups. The US Preventive Services Task Force calls PSA screening an individual decision from 55 to 69. For living longer and better, the research is about screening and treatment choices; the two big supplement evaluations found no benefit, and one found harm.
In This Article
- An enlarged prostate affects about a third of men over 65
- Urinary symptoms that need care right away
- Most men with early prostate cancer live a long time
- PSA screening: fewer prostate cancer deaths, more diagnoses
- What US guidelines say, and where they differ
- Saw palmetto didn’t help, and vitamin E raised cancer risk
- The studies and numbers behind all of this
Key Takeaways
- An enlarged prostate is noncancerous and mainly causes urinary symptoms. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates it affects about a third of men 65 and older.
- In the ProtecT trial of PSA-detected cancer that had not spread, deaths from prostate cancer were low across monitoring, surgery and radiation groups over 15 years. Cancer spread more often with monitoring; treatment had lasting urinary, bowel and sexual side effects.
- In the European screening trial, about one prostate cancer death was prevented per 456 men invited over 23 years. Screening also led to more diagnoses, including cancers that might never cause harm.
- The US Preventive Services Task Force treats screening as an individual decision from 55 to 69 and recommends against it from 70. Urology guidance starts discussion earlier, particularly for higher-risk men. The Task Force recommendation was under update as of September 26, 2026.
- Cochrane reviewers found little to no urinary-symptom benefit from saw palmetto alone. SELECT found no prostate-cancer prevention benefit from vitamin E or selenium, and vitamin E alone raised risk.
- Fewer prostate cancer deaths do not establish longer life overall. Screening trials have not shown that overall survival benefit.
How common is prostate enlargement?
Benign prostatic hyperplasia, or BPH, is a noncancerous growth of the prostate. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the NIH, estimates it affects about 1 in 20 men aged 40 to 64 and roughly a third of men 65 and older. The prostate has a second growth phase that starts around age 25 and continues throughout life, the institute says, and BPH often shows up late in it.
The prostate wraps around the urethra, the tube that carries urine out of the bladder. As it grows, it can squeeze that tube. The NIDDK’s symptom list includes “trouble starting a urine stream or emptying your bladder” and “a weak or interrupted urine stream, or dribbling at the end of urination,” along with urgency, frequency and waking at night to urinate. Prostate cancer is on the institute’s list of other problems that can cause similar symptoms, which is one reason it says to discuss any urinary symptoms with a health care professional.
The NIDDK says BPH can be treated with watchful waiting, medicines or surgery, and that lifestyle changes may also help. The American Urological Association’s BPH guideline, rewritten in 2026 in three parts, covers evaluation, medicines and lifestyle changes, and procedures and surgery. In the procedures section, its authors say shared decision-making is essential for tailoring treatment to each patient. A urologist can match the options to symptoms and prostate size. More on the guidance
When to get help right away
The NIDDK says to tell a health care professional right away if you “cannot urinate at all,” feel painful, frequent and urgent needs to urinate “and have a fever and chills,” “have blood in your urine,” or “feel great discomfort or pain in your lower abdomen or urinary tract.”
Cancer: stage changes the outlook
About 13% of American men, roughly 1 in 8, will be diagnosed with prostate cancer at some point, according to the National Cancer Institute’s SEER program. The median age at diagnosis is 68: half are diagnosed younger and half older. Most cancers are found before they spread. SEER reports five-year relative survival of about 98% overall and about 40% after distant spread. This compares survival with that expected in similar people without the cancer; it is not a personal prediction or a measure of treatment benefit. Non-Hispanic Black men have the highest rates of both diagnosis and death, with a death rate nearly double the overall rate. See the numbers
What localized prostate cancer does over time is the question the UK’s ProtecT trial was built to answer. Researchers led by Freddie Hamdy of the University of Oxford randomly assigned men aged 50 to 69, whose cancer had been found by PSA testing and hadn’t spread, to active monitoring (regular tests to check on the cancer), surgery or radiotherapy. After a median of 15 years:
- Prostate cancer deaths were low in all three groups: about 3% with monitoring, about 2% with surgery and about 3% with radiotherapy. The study could not establish a difference in prostate cancer deaths between the groups; that does not mean the treatments had identical effects.
- Spread was more common with monitoring: metastases, meaning cancer in distant parts of the body, developed in about 9% of monitored men, versus about 5% with surgery or radiation.
- No treatment at all: about a quarter of the monitored men were alive without ever having needed treatment.
- Side effects: according to the University of Oxford, the effects of surgery and radiotherapy on urinary, bowel and sexual function lasted much longer than previously thought.
Over the same years, other causes of death claimed about seven times as many of these men as prostate cancer did. Hamdy, the trial’s lead investigator, said in the university’s announcement that “a diagnosis of prostate cancer should not be a cause for panic or rushed decision making.” The trial was government-funded (Note 1). How the trial worked
What did the long PSA-screening trial find?
PSA screening finds more cancer. Whether finding it helps is the question the European Randomized Study of Screening for Prostate Cancer (ERSPC) has tracked since 1993. Its 23-year results, reported in 2025 by Monique Roobol of Erasmus MC Cancer Institute in Rotterdam and colleagues, cover men aged 55 to 69 in eight European countries.
Men invited to screening had about 13% fewer prostate cancer deaths. In absolute terms, one prostate cancer death was prevented for every 456 men invited. Screening also led to about 30% more prostate cancer diagnoses. The authors wrote that future screening should adopt risk-based approaches to keep overdiagnosis to a minimum, meaning the detection of cancers that would never have caused harm. The Dutch Cancer Society was among the funders (Note 2).
The trial did not establish that screening reduced deaths from all causes combined, a point raised in a letter to the journal. Roobol and co-author Anssi Auvinen replied that the trial was designed around prostate cancer deaths and may not have been large enough to detect a smaller change in overall deaths (Note 3). The screening numbers
How would the chance of preventing a prostate cancer death weigh against finding and possibly treating a cancer that would never cause harm?
What US guidelines say
The US Preventive Services Task Force, an independent national panel, says that for men 55 to 69, “the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one.” For older men, it “recommends against PSA-based screening for prostate cancer in men 70 years and older.” That recommendation dates from 2018. As of September 26, 2026, the Task Force lists an update in progress, and no draft of a new recommendation has been posted.
The American Urological Association and the Society of Urologic Oncology, whose guideline was updated in February 2026, start the conversation earlier. They say clinicians may offer a baseline PSA test between 45 and 50, and should offer screening from 40 to 45 to men at higher risk: Black men, men with certain inherited gene mutations and men with a strong family history. Their 2023 version recommended PSA screening combined with shared decision-making and encouraged online risk calculators. Some panel members reported consulting ties to drug and imaging companies (Note 4). Both guidelines in detail
How the decision fits into each decade is covered in Healthy Aging for Men in Their 60s.
Have prostate supplements shown a benefit?
Saw palmetto. A 2023 Cochrane review by Juan Franco of Heinrich Heine University Düsseldorf and colleagues pooled 27 trials involving men with urinary symptoms attributed to benign prostate enlargement. Saw palmetto made little to no difference to urinary symptoms compared with a placebo, the reviewers found, based on high-certainty evidence. Ten of the trials were funded by the pharmaceutical industry.
Vitamin E and selenium. The SELECT trial, reported by Eric Klein of Cleveland Clinic and colleagues, randomly assigned healthy men in the US, Canada and Puerto Rico to vitamin E (400 IU a day), selenium, both or a placebo. Neither supplement prevented prostate cancer. Vitamin E alone raised prostate cancer risk by about 17%, or about 1.6 extra cases for every 1,000 men followed for a year. The authors concluded that vitamin E “significantly increased the risk of prostate cancer among healthy men.” The US National Cancer Institute funded the trial; supplement companies supplied the pills (Note 5). The supplement trials in detail
Does a prostate-supplement claim concern easier urination, fewer cancers, or longer life—and has it actually measured that outcome?
What’s Interesting
The two long trials, read together, tell a quieter story than the headlines. ERSPC shows screening prevents some prostate cancer deaths. In ProtecT’s men aged 50 to 69 with PSA-detected, localized cancer, deaths from other causes far outnumbered prostate cancer deaths across all three assigned groups. Put side by side, they help explain the interest in active monitoring for low-risk cancer, and in the risk-based screening the ERSPC authors called for.
There’s also a split in how different groups read the same evidence. A 2026 commentary by Takeshi Takahashi, a physician at the Health and Welfare Bureau in Kitakyushu, Japan, notes that the Task Force’s cautious language and the urology guidelines’ more favorable view come from weighing prostate cancer deaths and overall survival differently. Same trials, different emphasis. The ERSPC authors framed the goal as reducing overdiagnosis while keeping the clinical benefits.
What This Means in Practice
For living longer and better, prostate health after 50 is mostly about informed decisions. The trials describe averages across thousands of men, so a clinician who knows your history can place you within them.
- Mention urinary changes. The NIDDK says to discuss any urinary symptoms with a health care professional; weak flow, urgency and nighttime urination are classic BPH symptoms, and the institute notes that other problems, including prostate cancer, can cause them too.
- Urgent symptoms. NIDDK advises care right away for inability to urinate, blood in urine, painful and urgent urination with fever and chills, or great discomfort or pain in the lower abdomen or urinary tract.
- Screening eligibility. The Task Force’s shared decision starts at 55. The urologists’ guideline suggests a baseline test from 45 to 50, and from 40 to 45 for Black men and men with a strong family history or known gene mutations.
- Monitoring versus treatment. ProtecT’s investigators frame the choice for localized cancer as a tradeoff: low prostate cancer mortality across groups, more spread with monitoring, and lasting side effects from treatment. Hamdy cautions against rushed decisions; individual cancer risk still matters.
- On supplements, the SELECT authors found vitamin E raised prostate cancer risk, and Cochrane reviewers found saw palmetto made little to no difference to urinary symptoms.
A primary care clinician can start the PSA conversation. A urologist handles BPH treatment, abnormal PSA results and cancer care.
Bottom Line
Two conditions account for most of prostate health as you age. An enlarged prostate is common after 65 and mainly affects urination, with many treatments available. Prostate cancer is also common, but stage matters. In ProtecT, about 3% of men with PSA-detected cancer that had not spread died of it over 15 years across the three treatment groups. PSA screening cut prostate cancer deaths by about 13% in ERSPC but increased diagnoses, which is why US guidance treats it as an individual decision from 55 to 69. Saw palmetto hasn’t helped symptoms, and vitamin E raised cancer risk. Whether screening extends overall life remains unknown, and the US recommendation is being updated. Symptoms, cancer risk and preferences about screening harms are distinct parts of the clinician conversation described by NIDDK and the Task Force.
A NOTE FROM LONGEVITY365
We read research, consult expert perspectives and work to make complicated health information easier to understand. What you’re reading here reflects how we’ve interpreted and organized that information. It is educational content—not personal medical advice, diagnosis or treatment guidance.
We’re not perfect, and neither is the available research. Evidence changes, new studies emerge and what’s appropriate for one person may not be appropriate for another.
Use this article as a starting point for your own research and conversations with qualified professionals. Always talk with your doctor or another trusted healthcare professional before making decisions that could affect your health, particularly if you take medications, are receiving treatment, have existing health conditions, are pregnant or have other circumstances that could affect what’s appropriate for you.
Reader Questions
A few questions to carry into the comments or your next conversation. Please leave out identifying or personal medical details.
- 01What changes when urinary symptoms, cancer risk and screening are treated as separate questions?
- 02Which screening tradeoff would you want explained more fully: false alarms, missed cancers, overdiagnosis or treatment side effects?
- 03What would you want to understand about monitoring versus treatment after a localized cancer diagnosis?
Extra Insights & Sources
For readers who want the details behind each claim above.
What We Know
- BPH affects about a third of men 65 and older and causes urinary symptoms; several effective treatments exist. Established.
- In ProtecT, men with localized prostate cancer detected by PSA had about a 3% 15-year prostate cancer death rate across assigned groups; spread and treatment harms differed. Supported.
- Screening reduces prostate cancer deaths modestly and increases diagnoses. Supported.
- Saw palmetto doesn’t help urinary symptoms; vitamin E raises prostate cancer risk. Supported.
What We Don’t Know
- Whether PSA screening helps men live longer overall. Unknown. Trials were designed to measure prostate cancer deaths, and ERSPC did not show a statistically significant overall-survival benefit.
- How the USPSTF’s update will change US guidance. Uncertain.
- Which men with low-risk cancer will progress. Uncertain.
- Whether any diet or supplement prevents prostate cancer. Unknown; the major supplement trial found harm.
BPH: the figures and the guidance
The NIDDK page (last reviewed June 2024) says: “Experts estimate that BPH affects 5% to 6% of men ages 40 to 64 and 29% to 33% of those ages 65 and older.” It adds that BPH is “the most common prostate problem in men older than age 50.” Its symptom list also includes nocturia (waking at night to urinate), urinary urgency (a sudden need to go), urinary frequency (going often) and pain during urination, and its list of other problems that can cause similar symptoms includes bladder problems, urinary tract infections, prostatitis and prostate cancer.
The American Urological Association’s (AUA’s) 2026 BPH guideline was published in the Journal of Urology in three parts (presentation and evaluation; medical management, including behavioral and lifestyle interventions; and procedural and surgical management), first author Ramy Goueli, senior author Jaspreet Sandhu. Its systematic review searched the literature through January 2025, with an update search on December 15, 2025. Part III concludes that choosing a procedure means balancing how well it works, how long its benefit lasts and the side effects specific to each procedure. It replaces the 2023 amendment, which had revised statements on combination drug therapy and several procedures: photoselective vaporization (using a laser to vaporize prostate tissue), water vapor thermal therapy (using steam to shrink tissue), laser enucleation (separating and removing excess tissue with a laser) and prostate artery embolization (blocking selected blood vessels supplying the prostate).
Prostate cancer by the numbers
SEER’s stat facts page estimates 333,830 new prostate cancer cases and 36,320 deaths in the US in 2026. Approximately 13.2% of men will be diagnosed during their lifetime (2021–2023 data). The median age at diagnosis is 68 and the median age at death from prostate cancer is 79. Five-year relative survival is 98.2% overall (2016–2022) and 40.1% for cancer that has spread to distant sites; 69% of cases are found while still localized. The age-adjusted death rate is 18.9 per 100,000 men overall and 36.2 for non-Hispanic Black men; the rate of new cases is 123.2 per 100,000 overall and 200.1 for non-Hispanic Black men.
ProtecT in detail
Between 1999 and 2009, 82,429 UK men aged 50 to 69 had a PSA test; 2,664 were diagnosed with localized prostate cancer and 1,643 were randomized: 545 to active monitoring, 553 to prostatectomy (surgical removal of the prostate) and 545 to radiotherapy (radiation treatment). At a median follow-up of 15 years (range 11 to 21), follow-up was complete for 98%. More than a third of the men had intermediate- or high-risk disease at diagnosis.
| Outcome | Active monitoring | Surgery | Radiotherapy |
|---|---|---|---|
| Died of prostate cancer | 17 (3.1%) | 12 (2.2%) | 16 (2.9%) |
| Metastases | 51 (9.4%) | 26 (4.7%) | 27 (5.0%) |
| Long-term hormone therapy | 69 (12.7%) | 40 (7.2%) | 42 (7.7%) |
| Clinical progression (worsening cancer) | 141 (25.9%) | 58 (10.5%) | 60 (11.0%) |
Prostate cancer deaths totaled 45 (2.7%), with P = 0.53 for the overall comparison, meaning this trial did not establish a difference between groups. Deaths from any cause totaled 356 (21.7%), similar across groups, so 311 men died of other causes, about seven times the 45 prostate cancer deaths. In the monitoring group, 133 men (24.4%) were alive without any prostate cancer treatment at the end of follow-up. The authors concluded that deaths from prostate cancer were low whichever treatment was assigned, so choosing a therapy means weighing the trade-offs between benefits and harms. In the University of Oxford’s announcement, Hamdy added that “Most men with localised prostate cancer are likely to live for a long time, whether or not they receive invasive treatment and whether or not their disease has spread.” Published in the New England Journal of Medicine, 2023 (Note 1).
ERSPC in detail
The trial involved 162,236 men. In the figures below, a rate ratio of 1 means no difference; 0.87 means a 13% lower rate and 1.30 a 30% higher rate. Confidence intervals (CI) describe the uncertainty around the estimates. The 0.22 percentage-point absolute reduction amounts to about 2 fewer prostate cancer deaths per 1,000 men over follow-up.
ERSPC randomized men aged 55 to 69 to repeated PSA testing or no invitation. After a median of 23 years, the prostate cancer mortality rate ratio was 0.87 (95% CI 0.80 to 0.95), an absolute risk reduction of 0.22% (95% CI 0.10 to 0.34). Cumulative incidence was higher with screening (rate ratio 1.30; 95% CI 1.26 to 1.33). One prostate cancer death was prevented for every 456 men invited (95% CI 306 to 943), with 12 additional prostate cancer diagnoses per death prevented, compared with 628 invitations and 18 additional diagnoses at 16 years. The 12 refers to the extra diagnoses in the screening group compared with the control group, not to all men diagnosed or to a 1-in-12 chance that a diagnosed man benefits. The authors concluded that the long-term follow-up confirms a lasting reduction in prostate cancer deaths with PSA testing, along with an improved balance of harms and benefits. PubMed lists a March 2026 erratum to the paper; the abstract results above are as currently published. Cumulative incidence is the proportion diagnosed over follow-up. The overall-survival exchange comes from Takahashi’s 2026 commentary in Translational Andrology and Urology, which summarizes the published letters and the authors’ reply (Note 3); Takahashi declared no conflicts of interest.
The screening guidelines in their own words
USPSTF (final recommendation, May 8, 2018). Men 55 to 69 get a grade C, meaning the decision depends on individual circumstances and preferences because the expected net benefit is small. “Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician,” the statement says, and it adds: “Clinicians should not screen men who do not express a preference for screening.” Men 70 and older get a grade D, a recommendation against screening in that age group. The Task Force’s update page (last updated December 21, 2023) shows a final research plan and says public comments are closed; no draft recommendation appeared there as of September 26, 2026.
AUA/SUO (2023, amended 2026). The 2026 update (Journal of Urology, first author Daniel Lin) reviewed evidence published between November 2022 and December 2024. Its statements, paraphrased: clinicians should use shared decision-making and proceed according to each person’s values and preferences; they may begin screening and offer a baseline PSA test between ages 45 and 50; they should offer screening from age 40 to 45 to people at increased risk because of Black race, inherited (germline) mutations or a strong family history of prostate cancer; and they should offer regular screening every 2 to 4 years from age 50 to 69. The 2023 version, first author John Wei, encouraged the use of online risk calculators and said data from population-based cohorts support longer screening intervals and tailored screening (Note 4).
The supplement trials in detail
SELECT randomized 35,533 men. In the results below, HR means hazard ratio: values above 1 indicate a higher rate during follow-up, and values below 1 a lower rate. CI means confidence interval, a range describing uncertainty. A person-year is one person followed for one year; 1,000 person-years could also be 100 people followed for 10 years.
Cochrane saw palmetto review (2023). 27 randomized trials, 4,656 participants: 19 compared saw palmetto with placebo and 8 tested it in combination with other plant extracts. Ten were funded by the pharmaceutical industry, two by government agencies, and the rest didn’t specify funding. At short-term follow-up, the symptom-score difference was −0.90 points (95% CI −1.74 to −0.07; 9 studies, 1,681 participants; high-certainty evidence); at 12 to 17 months it was 0.07 (95% CI −0.75 to 0.88; high-certainty). The International Prostate Symptom Score runs from 0 to 35, with higher scores meaning worse symptoms; a negative difference favors saw palmetto. The reviewers used a 3-point improvement as the minimum clinically important difference. The short-term estimate and its whole confidence interval fall short of that size: the small difference is statistically detectable, but below the review’s threshold for a meaningful symptom benefit. The reviewers concluded that saw palmetto on its own offers little to no benefit for men with lower urinary tract symptoms caused by benign prostatic enlargement. The review authors declared no known conflicts of interest.
SELECT (2011 update). Men were eligible at 50 or older if Black and 55 or older otherwise, with a PSA of 4.0 ng/mL or less (nanograms per milliliter of blood). The primary analysis included 34,887 men. Compared with 529 prostate cancers in the placebo group, there were 620 with vitamin E (HR 1.17; 99% CI 1.004 to 1.36; P = .008), 575 with selenium (HR 1.09; not significant) and 555 with both (HR 1.05; not significant). The absolute increase per 1,000 person-years was 1.6 for vitamin E, 0.8 for selenium and 0.4 for the combination. Published in JAMA (Note 5).
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases: Prostate Enlargement (Benign Prostatic Hyperplasia)
- National Cancer Institute SEER: Cancer Stat Facts: Prostate Cancer
- Hamdy FC, et al. ProtecT 15-year outcomes, New England Journal of Medicine, 2023: PubMed 36912538
- University of Oxford: Study shows delaying treatment for localised prostate cancer does not increase mortality risk (March 13, 2023)
- Roobol MJ, et al. ERSPC 23-year follow-up, New England Journal of Medicine, 2025: PubMed 41160819
- Takahashi T. Prostate cancer screening and evidence: the role of overall survival, Translational Andrology and Urology, 2026: PubMed 42164360
- US Preventive Services Task Force: Prostate Cancer: Screening (2018) and update in progress
- Lin DW, et al. Updates to Early Detection of Prostate Cancer: AUA/SUO Guideline (2026), Journal of Urology, 2026: PubMed 41744286
- Wei JT, et al. Early Detection of Prostate Cancer: AUA/SUO Guideline Part I, Journal of Urology, 2023: PubMed 37096582
- Goueli R, et al. Management of LUTS Attributed to BPH: AUA Guideline (2026) Part I, Journal of Urology, 2026: PubMed 42095481; Part III: PubMed 42095468
- Sandhu JS, et al. BPH: AUA Guideline Amendment 2023, Journal of Urology, 2024: PubMed 37706750
- Franco JVA, et al. Serenoa repens for BPH symptoms, Cochrane Database of Systematic Reviews, 2023: PubMed 37345871
- Klein EA, et al. Vitamin E and the risk of prostate cancer (SELECT), JAMA, 2011: PubMed 21990298
Notes
Note 1: ProtecT was funded by the UK’s National Institute for Health and Care Research.
Note 2: ERSPC was funded by the Dutch Cancer Society and others, according to the published abstract; the full funder list isn’t given there.
Note 3: The overall-survival point and the authors’ reply come from a published summary, not the letters themselves: Takeshi Takahashi’s 2026 editorial commentary in Translational Andrology and Urology.
Note 4: The AUA funded the guideline panel, and panel members received no payment for their work. In the 2026 disclosures, Daniel Lin reported consulting for Astellas and Janssen, Badrinath Konety for Asieris, Abbott and Valar Labs, and Andrei Purysko reported research roles with Profound Medical, Lantheus, Blue Earth Diagnostics and Siemens Healthineers.
Note 5: SELECT was funded by the US National Cancer Institute and the National Center for Complementary and Alternative Medicine. Study supplements and packaging were provided by Perrigo Company, Sabinsa Corporation, Tishcon Corporation and DSM Nutritional Products. The paper lists 16 of its authors, including Klein, as having no disclosures to report.
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