From the Guidelines
Prostate-Specific Antigen (PSA) Screening Guidelines: The American Urological Association and other relevant guidelines recommend starting Prostate-Specific Antigen (PSA) screening at age 55 for average-risk men and stopping at age 70 1. However, for men at higher risk, such as those with a family history of prostate cancer, screening may start at age 40 or 45 1.
Key Considerations
- Men with a life expectancy of less than 10 years should not undergo PSA screening 1.
- It is essential to discuss individual risk factors and benefits with a healthcare provider to determine the best approach for each patient 1.
Risk Stratification
- Men at average risk should receive information about PSA screening beginning at age 50 years 1.
- Men at higher risk, including African American men and men with a family member diagnosed with prostate cancer before age 65 years, should receive this information beginning at age 45 years 1.
- Men at appreciably higher risk (multiple family members diagnosed with prostate cancer before age 65 years) should receive this information beginning at age 40 years 1.
Screening Intervals
- For men who choose to be screened for prostate cancer, screening is recommended with a PSA test, with or without DRE 1.
- Screening intervals can be extended to every 2 years for men with PSA levels less than 2.5 ng/mL, and screening should be conducted yearly for men with PSA levels of 2.5 ng/mL or higher 1.
From the Research
Prostate-Specific Antigen (PSA) Screening Guidelines
- The American Urological Association (AUA) recommends shared decision-making for average-risk men aged 55-69 years considering PSA-based screening for prostate cancer detection 2.
- The AUA guideline recommends against routine screening for men at average risk outside of the 55-69 years age range 2.
- Other organizations, such as the American Cancer Society (ACS), recommend screening based on age and risk, with informed discussion between provider and patient 3.
- The United States Preventative Health Service Task Force (USPSTF) states that evidence is insufficient to assess the risks and benefits of prostate cancer screening in men younger than 75 years 3.
Age to Start PSA Screening
- Some studies suggest that a baseline PSA should be obtained at age 40 4, 3.
- However, the AUA guideline recommends against routine screening in men aged 40-54 years at average risk 2, 5.
- A study found that 32% of average-risk men aged 40-54 years had cancer, and 23% had Gleason score ≥ 7 disease, which would have been missed or delayed if the AUA guidelines were followed 5.
Age to Stop PSA Screening
- There is no clear consensus on the age to stop PSA screening, but the AUA guideline recommends against routine screening in men at average risk outside of the 55-69 years age range 2.
- The USPSTF states that evidence is insufficient to assess the risks and benefits of prostate cancer screening in men younger than 75 years, implying that screening may not be necessary for men over 75 years 3.
- A review of evidence from randomized trials suggests that the benefits of PSA screening may outweigh the harms in men aged 55-69 years, but the harms associated with screening, such as false-positive results and complications of biopsy and treatment, should be considered 6.