From the Guidelines
Men with a family history of prostate cancer should begin PSA screening at age 40-45, rather than the standard recommendation of age 50, to account for their increased risk and the potential for earlier development of prostate cancer. This recommendation is based on the most recent and highest quality study available, which suggests that men at higher risk, including those with a family member diagnosed with prostate cancer before age 65, should receive information about prostate cancer screening beginning at age 45 1. However, for men at appreciably higher risk, such as those with multiple family members diagnosed with prostate cancer before age 65, screening should begin at age 40 1.
The screening process involves a simple blood test measuring prostate-specific antigen levels, with results generally considered normal when below 4 ng/mL, though this can vary by age. After initial screening, follow-up testing frequency depends on the baseline PSA level—typically annually if the PSA is elevated or every 2-4 years if normal. This earlier and potentially more frequent screening is recommended because prostate cancer often develops 5-10 years earlier in men with a family history, and early detection significantly improves treatment outcomes.
Some key points to consider when deciding on PSA screening include:
- The benefits and limitations of PSA testing, including the potential for unnecessary procedures for slow-growing cancers that might never cause symptoms
- The importance of individualized risk assessment, taking into account factors such as family history, age, and overall health status
- The need for informed decision-making, with men receiving information about the benefits, risks, and uncertainties associated with prostate cancer screening and therapy
- The role of patient decision aids in preparing men to make a decision about whether to be tested
It's essential to note that the decision to begin screening should be made after discussing the benefits and limitations with a healthcare provider, as PSA testing can sometimes lead to unnecessary procedures for slow-growing cancers that might never cause symptoms 1.
From the Research
Prostate Cancer Screening with Family History
- Men with a family history of prostate cancer are at increased risk of developing the disease 2
- The risk of prostate cancer is higher with a greater proximity of relatedness, greater number of family members affected, and/or earlier age at diagnosis of the family member 2
- Family history should be considered alongside PSA level for prostate cancer risk assessment 2
Screening Guidelines
- The earliest age for screening high-risk men, including those with a family history of prostate cancer, is 40 years, but recommendations often defer to clinical judgement 3
- Most guidelines recommend screening every 2 to 4 years in men 55 to 69 years of age at average risk 4
- For men with a family history of prostate cancer, screening may be recommended at an earlier age, but the specific age is not universally agreed upon 3, 4
PSA Testing
- PSA values were significantly greater in men with prostate cancer than in men without prostate cancer, even with PSA levels less than 4.0 ng/mL 5
- The odds of prostate cancer nearly doubled for a doubling of the PSA level within this interval 5
- A positive family history of prostate cancer increases the risk of prostate cancer on initial prostate biopsy, including both high-grade and low-grade prostate cancer 6