From the Guidelines
PSA screening typically begins at age 50 for men at average risk of prostate cancer, but may start earlier for those at higher risk, including African American men and those with a family history of prostate cancer, at age 45, and as early as age 40 for men with multiple first-degree relatives who had prostate cancer at an early age. The decision to undergo PSA screening should be individualized through shared decision-making between a man and his healthcare provider, weighing the potential benefits of early detection against the risks of overdiagnosis and overtreatment 1. Some key points to consider when deciding on the age to start PSA screening include:
- Men at average risk should receive information about PSA screening starting at age 50 years
- Men at higher risk, including African American men and those with a family history of prostate cancer, should receive information starting at age 45 years
- Men with multiple first-degree relatives who had prostate cancer at an early age should receive information starting at age 40 years
- Asymptomatic men who have less than a 10-year life expectancy based on age and health status should not be offered prostate cancer screening 1. Most guidelines suggest discontinuing routine PSA screening at age 70 or when life expectancy is less than 10 years, as the potential harms may outweigh the benefits in older men 1.
From the Research
PSA Screening Age
- The age at which PSA screening is done varies, but most studies suggest that it is commonly recommended for men aged 50-74 years 2.
- A study found that 51.5% of respondents recommended PSA-based screening for men aged 40-49 years, while nearly all endorsed it for those aged 50-74 years 2.
- For men aged 75-79 and ≥80 years, screening recommendations decreased to 43.9% and 12.8%, respectively 2.
- Another study suggested that PSA testing for men at average risk of prostate cancer is one of the most contested issues in cancer screening, and there is no formal screening program 3.
- A study on men aged <50 years found that the operating characteristics of PSA are more sensitive and specific than in older men, and diagnostic PSA levels in men aged <50 years are significantly lower than suggested by guidelines 4.
Screening Recommendations
- Urologists were more likely to recommend screening for men aged 40-49 and 50-59 years, but less likely for men aged 75-79 and ≥80 years compared with radiation oncologists 2.
- A study found that incorporating PSA velocity into a multivariable model for prostate cancer detection led to a very small increase in area under the curve, and biopsying men with high PSA velocity but no other indication would lead to a large number of additional biopsies 5.
- The role of PSA in detection and management of prostate cancer is well established, but the lack of sensitivity and specificity that characterizes PSA testing in the initial diagnosis of prostate cancer largely disappears after treatment of localized prostate cancer 6.