From the Guidelines
Prostate-Specific Antigen (PSA) screening should begin at age 50 for men at average risk of prostate cancer, but for those at higher risk, including African American men and men with a family history of prostate cancer, screening should start at age 45, and as early as age 40 for men with multiple first-degree relatives diagnosed with prostate cancer at an early age. This recommendation is based on the most recent guidelines from reputable organizations, including the American Cancer Society 1 and the US Preventive Services Task Force 1. The decision to start PSA screening at a certain age should be individualized, taking into account a man's personal risk factors, overall health status, and life expectancy.
Key Considerations for PSA Screening
- Men at average risk should receive information about the benefits, risks, and uncertainties associated with prostate cancer screening starting at age 50 years 1.
- Men at higher risk, including African American men and men with a family history of prostate cancer, should receive this information starting at age 45 years 1.
- Men with multiple first-degree relatives diagnosed with prostate cancer at an early age should consider starting screening as early as age 40 1.
- The screening involves a simple blood test that measures PSA levels, with results generally considered concerning if above 4.0 ng/mL, though this threshold may vary based on age and other factors 1.
Importance of Informed Decision-Making
Before undergoing PSA screening, men should have a thorough discussion with their healthcare provider about the potential benefits and limitations of testing, including the risk of overdiagnosis and unnecessary treatment of slow-growing cancers that might never cause symptoms 1. This informed decision-making process is crucial to ensure that men are aware of the potential risks and benefits of PSA screening and can make an informed decision that is right for them.
Ongoing Screening and Monitoring
Regular screenings should typically continue until around age 70, depending on health status, with the frequency of screening determined by PSA levels and other risk factors 1. Men with PSA levels less than 2.5 ng/mL may be screened every 2 years, while those with PSA levels of 2.5 ng/mL or higher should be screened yearly 1.
From the Research
Age to Start Prostate-Specific Antigen (PSA) Screening
The age at which to start Prostate-Specific Antigen (PSA) screening is a topic of ongoing debate. According to the US Preventive Services Task Force, PSA screening for prostate cancer should involve men aged 55-69, based on a personal decision following consultation with a health professional 2.
- For men aged 55-69 years, 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.
- The US Preventive Services Task Force recommends against PSA-based screening for prostate cancer in men 70 years and older 2.
- A study published in 2017 suggests that PSA screening for prostate cancer can decrease prostate cancer mortality among men aged 50-54 years, with the number needed to invite and number needed to detect to prevent one prostate cancer death comparable to those previously reported from the European Randomized Study of Screening for Prostate Cancer for men aged 55-69 years 3.
Considerations for Screening
When considering PSA screening, several factors should be taken into account, including:
- Family history of prostate cancer
- Race/ethnicity
- Comorbid medical conditions
- Patient values about the benefits and harms of screening and treatment-specific outcomes
- Other health needs 2, 4
Benefits and Harms of Screening
The benefits of PSA screening include:
- Reduced risk of prostate cancer-specific mortality
- Reduced risk of metastatic prostate cancer
- Early detection and treatment of prostate cancer
The harms of screening include: