How often should Prostate-Specific Antigen (PSA) levels be rechecked?

From the Guidelines

The frequency of PSA testing should be individualized based on a man's age, overall health status, and previous PSA results, with testing every 2-4 years for men with low PSA levels (<1 ng/mL) and every 1-2 years for those with higher PSA levels (≥1 ng/mL) 1. The decision to screen for prostate cancer using the PSA test should be based on a discussion of the benefits and harms of screening, the patient's general health and life expectancy, and patient preferences 1. Key factors to consider when determining the frequency of PSA testing include:

• Age: Men under 50 years, over 69 years, or with a life expectancy of less than 10-15 years should not be screened 1
• PSA level: Men with low PSA levels (<1 ng/mL) can be screened less frequently (every 2-4 years), while those with higher PSA levels (≥1 ng/mL) should be screened more frequently (every 1-2 years) 1
• Risk factors: Men with a family history of prostate cancer or African American ethnicity may need to start screening earlier (age 40-45) and be screened more frequently 1
• Previous results: Men with elevated PSA results should have follow-up testing within 1-3 months to confirm the finding, while those with persistently elevated PSA but negative biopsies may need testing every 6-12 months with additional monitoring 1. It is essential to weigh the potential benefits of screening against the harms, including false-positive results, overdiagnosis, and overtreatment, and to engage in shared decision-making with patients to determine the best approach for each individual 1.

From the Research

Rechecking PSA Levels

• The frequency of rechecking Prostate-Specific Antigen (PSA) levels depends on various factors, including age, risk factors, and previous test results 2.
• For men between 55 and 69 years old at average risk, most guidelines recommend screening every 2 to 4 years 2.
• If a PSA test result is positive (more than 4 ng/mL), the test should be repeated to confirm the results 2.
• The primary intent of screening is to identify patients with clinically significant prostate cancer who may benefit from curative treatment while minimizing the detection of clinically insignificant cancer 2.

Detection and Diagnosis

• PSA testing in conjunction with digital rectal examination enhances early prostate cancer detection 3, 4.
• Prostatic biopsy should be considered if either the PSA level is greater than 4 micrograms/l or digital rectal examination is suspicious for cancer, even in the absence of abnormal transrectal ultrasonography findings 3.
• The combination of PSA and digital rectal examination seems to improve the stage of diagnosis of patients with prostate cancer 4.

Risk Stratification and Active Surveillance

• For men with low-risk prostate cancer, active surveillance is the preferred management, but a subset may harbor more aggressive disease 5.
• Various factors, including total volume of cancer, PSA density, and presence of ductal components, can help personalize clinical decision-making for men with low-risk prostate cancer 5.
• PSA kinetics, Prostate Imaging Reporting & Data System 4/5 lesions on MRI, and other factors can also help assess oncologic risk in these men 5.