What are the guidelines for prostate cancer screening in men?

From the Guidelines

Prostate cancer screening should be discussed with a doctor starting at age 50 for average-risk individuals or earlier at age 45 for high-risk groups, such as African American men or those with a family history of prostate cancer, and should involve shared decision-making to weigh potential benefits against risks. The primary screening methods include the prostate-specific antigen (PSA) blood test and digital rectal examination (DRE) 1. For PSA testing, a value below 4.0 ng/mL is typically considered normal, though some men with prostate cancer may have lower levels while others with higher levels may not have cancer. The frequency of screening depends on previous PSA results, with annual testing often recommended for those with PSA levels above 2.5 ng/mL and less frequent testing (every 2-4 years) for those with lower levels 1.

Some key points to consider in prostate cancer screening include:

• Men at average risk should receive information about the benefits and risks of screening starting at age 50 years, while those at higher risk (African American men or men with a family history of prostate cancer) should receive this information starting at age 45 years 1.
• Men with a life expectancy under 10 years may not benefit from screening due to the typically slow progression of prostate cancer 1.
• The goal of screening is to detect clinically significant cancers early while avoiding unnecessary treatment of indolent disease.
• Screening decisions should be individualized through shared decision-making between patient and doctor, weighing potential benefits against risks like false positives, unnecessary biopsies, and overtreatment of slow-growing cancers 1.
• The US Preventive Services Task Force recommends against PSA-based screening for prostate cancer in all age groups, citing the potential harms of screening, including false-positive results, unnecessary biopsies, and overtreatment of slow-growing cancers 1.

Overall, the decision to screen for prostate cancer should be made on an individual basis, taking into account a man's age, risk factors, and personal preferences, and should involve a discussion with a doctor about the potential benefits and risks of screening 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.
• Men at average risk should receive this information beginning at age 50, while men in higher-risk groups should receive this information before age 50 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.
• The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older 3.

Screening Frequency and Age

• Most guidelines recommend screening every 2 to 4 years in men 55 to 69 years of age at average risk 4.
• Starting screening at an early age appears to advance the time of prostate cancer diagnosis but does not seem to increase the risk of being diagnosed with the disease 5.
• Age at termination of screening is strongly associated with the risk of being diagnosed with prostate cancer 5.
• Baseline PSA testing at age 40 may be necessary to diagnose prostate cancer at a potentially curable stage in men aged <50 years, especially those with a life expectancy >20-25 years 6.

Shared Decision-Making

• Shared decision-making is strongly recommended by all national guidelines before initiating screening 4.
• Patient decision aids are helpful in preparing men to make a decision whether to be tested, and the use of such aids is encouraged 2.
• Clinicians should not screen men who do not express a preference for screening 3.

Potential Benefits and Harms

• PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened 3.
• Potential harms of screening include frequent false-positive results and psychological harms, as well as harms of prostate cancer treatment such as erectile dysfunction, urinary incontinence, and bowel symptoms 3.