Prostate cancer can lurk in your body for years without detection. You can take the upper hand by making sure a PSA (prostate specific antigen) test is added to your annual physical exam.

Early detection through PSA screening is a personal decision men can make to avoid the embarrassment of urinary incontinence and the pain of this cancer, which kills more than 40,000 men in the United States each year. This aggressive cancer can rapidly spread to lymph nodes, bones and other parts of the body if not detected in an early stage. PSA testing is the best way to assure you will live a long and healthy life.

The American Cancer Society (ACS) and the American Urological Association (AUA) both recommend annual screening for prostate cancer beginning at age 50. For those men who know cancer is in their family history, Dr. Robert J. Biber of the Midwest Urology Center suggests screening begin as early as age 40. “Men of African-American decent are also at a greater risk,” he says. “They should begin at 45.” The National Institutes of Health quotes the incidence of prostate cancer is 40 percent higher for African-American men than for white men and the number who will die is double that of white men.

The challenge of early detection is, of course, because prostate cancer has no symptoms in the early stages. As it spreads, prostate cancer may cause you to feel a constriction in the urethra with resulting urinary problems. In the later stages, inability to urinate — especially at night — and sharp pain at urination may result. A constant pain in one or more bones lasting two weeks or more also is symptomatic of advanced prostate cancer. Chronic pain in the lower back, hips or pelvis accompanied by fast weight loss is yet another symptom of advanced prostate cancer. If urinary problems begin appearing, it’s time to have a physical exam.

Here are the tests that can save your life:

Digital rectal exam According to a Mayo Clinic study, when researchers compared health records of 173 men who had died of prostate cancer with those of 346 healthy men, they found the deceased men were only half as likely to have had a digital exam included with their yearly physicals. So be sure this test is part of a yearly exam. Finding an enlarged prostate gland is the first step in early detection.

PSA test If your prostate is cancerous, it may pump more of a substance called prostate-specific antigen (PSA) than a healthy one does. A simple blood test can be used to check your PSA level. According to Dr. Biber, if you have no cancer in your body, the PSA level should be zero. A level between four and 10 could mean trouble and more testing should be done. A PSA level over 10ng/dl, or if your level has risen 1ng/dl in a year or less, you should have further testing immediately because this type of cancer may “invade other parts of the body through your bone structure.”

There are a number of options at this point, depending on whether you have an enlarged prostate, have already had prostate cancer, or never have had symptoms of the disease.