From the Guidelines
Prostate cancer screening is recommended for men aged 55 to 69 years through a shared decision-making process with their healthcare provider, as stated in the most recent and highest quality study 1. The primary screening test is the prostate-specific antigen (PSA) blood test, typically performed every 1-2 years. Men at higher risk, including African American men and those with a family history of prostate cancer, should consider beginning screening earlier, around age 40-45, as suggested by the American Cancer Society guidelines 1. The digital rectal examination (DRE) may be performed alongside PSA testing, especially for men with hypogonadism, due to the reduced sensitivity of PSA in this population 1. Some key points to consider when making a decision about prostate cancer screening include:
- The benefits of screening, including the potential to detect cancer early and reduce mortality, as seen in the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial 1
- The risks of screening, including false positives, overdiagnosis, and potential complications from subsequent treatments, as highlighted by the US Preventive Services Task Force (USPSTF) guideline 1
- The importance of individualizing the decision to screen based on personal values, risk factors, and overall health status, as emphasized by the American College of Physicians (ACP) guidance statement 1
- The need for shared decision-making between the patient and healthcare provider, as recommended by the ACP and other organizations 1 Screening is generally not recommended for men under 40 or over 70, or those with less than a 10-year life expectancy, due to the limited potential benefits and substantial harms associated with screening in these populations, as stated in the ACP guidance statement 1. Overall, the decision to screen for prostate cancer should be made on a case-by-case basis, taking into account the individual's unique risk factors, health status, and personal preferences, as recommended by the most recent and highest quality study 1.
From the Research
Prostate Cancer Screening Guidelines
- The American Cancer Society recommends that asymptomatic men who have at least a 10-year life expectancy have an opportunity to make an informed decision with their health care provider about screening for prostate cancer after receiving information about the uncertainties, risks, and potential benefits associated with prostate cancer screening 2.
- The US Preventive Services Task Force (USPSTF) recommends that the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one and should include discussion of the potential benefits and harms of screening with their clinician for men aged 55 to 69 years 3.
- For men 70 years and older, the USPSTF recommends against PSA-based screening for prostate cancer 3.
- Most guidelines recommend screening every 2 to 4 years in men 55 to 69 years of age at average risk 4.
- Screening via prostate-specific antigen testing may lead to a small reduction in prostate cancer-specific mortality, with no reduction in all-cause mortality, but it can cause significant harms related to false-positive test results, unnecessary biopsies, overdiagnosis, and overtreatment 4.
Screening Age
- Current prostate cancer screening guidelines conflict with respect to the age at which to initiate screening 5.
- A population-based cohort study found that PSA screening for prostate cancer can decrease prostate cancer mortality among men aged 50-54 yr 5.
- Guideline groups could consider whether guidelines for PSA screening should recommend starting no later than at ages 50-54 yr 5.
Detection Methods
- Digital rectal examination (DRE), determination of the prostate-specific antigen (PSA) value, and transrectal ultrasonography (TRUS) are the current methods of detection for prostate cancer 6.
- The PSA level is as effective as or more effective than DRE for the detection of prostate cancer 6.
- The combined use of DRE and PSA testing provides a more complete evaluation of the prostate gland for malignant involvement 6.
- TRUS is more costly and does not add appreciable detectability when results of both the DRE and the PSA determination are normal 6.