James Pickens Jr. had a prostate cancer screening every year for more than two decades, and he still developed the disease. The Grey's Anatomy star began prostate-specific antigen (PSA) testing at 41, and his urologist said that diligence helped catch it so early.

Screening looks for cancer before it causes symptoms. But a clear result is no guarantee, and the American Cancer Society says about 15 per cent of men with a PSA below 4 ng/mL will still have prostate cancer if a biopsy is done.

According to the US Centers for Disease Control and Prevention, there is no standard test for prostate cancer screening. The main one is the PSA blood test, which measures a substance made by the prostate gland.

Pickens' Diagnosis Despite Testing

Pickens' doctors noticed his PSA levels rising during an annual physical. He was referred to a urologist, and an MRI and biopsy found a tumour in his prostate. Further scans showed the cancer had not spread.

'Anytime you hear the "C" word, there's trepidation,' Pickens says. 'But I was as prepared as I could be. I had information and that brought solace to me.'

Prostate cancer ran through his family. More than half a dozen relatives, including his father, had faced the disease, so he would have been surprised to escape it.

Treatment Choices and Recovery

Pickens was offered radiotherapy or a radical prostatectomy, an operation to remove the entire prostate gland. He chose surgery, and lymph nodes were also removed.

He has a rare variant of the disease, which his doctors wanted to watch closely. They had not seen one found as early as his. He is now cancer-free, though it will be monitored.

His first thought after the diagnosis was how to get men tested. He asked the show's executive producer if writers could give his Grey's Anatomy character, Dr Richard Webber, a storyline that mirrored his own journey.

The hardest part was staying out of his own head. His wife, singer Gina Taylor, helped on low days. He was told that sexual function should return and that medication can help.

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Reading PSA Results

Many doctors use a PSA of 4 ng/mL or higher as a cue for further testing, while some start at 2.5 or 3. A level between 4 and 10 carries about a one in four chance of cancer, and above 10 the chance passes 50 per cent.

Older age, an enlarged prostate, an infection of the prostate and some procedures can raise PSA. Drugs such as finasteride and dutasteride can lower it, so men should tell their doctor what they take.

A raised PSA does not always mean cancer. A doctor may repeat the test, order an MRI or advise a biopsy, which is the only way to confirm prostate cancer for certain.

Who Should Consider Screening

The US Preventive Services Task Force recommends that men aged 55 to 69 without symptoms make their own decision about PSA screening after discussing the benefits and risks with a doctor. It advises against routine screening from age 70.

Dr Christian Pavlovich of Johns Hopkins Medicine says men aged 40 to 54 may need screening if a father or brother had the disease or they are African American, a group at higher risk of more aggressive cancers. His family history is one of those risks.

Pickens hopes his experience encourages more men, especially African American men, to get checked. He says prostate cancer is highly treatable, but early detection is key and there are sometimes no noticeable symptoms.

He wants to ease the stigma that keeps men from discussing prostate health. Anyone considering a PSA test, including an at-home kit, should weigh the pros and cons with a doctor.

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