From the Guidelines
The current screening protocol for prostate cancer involves prostate-specific antigen (PSA) blood testing and digital rectal examination (DRE) for men at average risk starting at age 50, with individualized screening decisions made through shared decision-making between patient and physician, taking into account the potential benefits and risks of screening, as recommended by the American Cancer Society 1.
Key Considerations
- Men at higher risk, including African American men and those with a family history of prostate cancer, should receive information about screening starting at age 45 or even 40, depending on their risk level 1.
- The American Cancer Society recommends that men with a PSA level below 2.5 ng/mL may be tested every 2 years, while those with higher levels should be screened annually 1.
- Screening decisions should be individualized, weighing the potential benefits of early detection against risks of overdiagnosis and overtreatment, and considering the patient's general health, preferences, and values 1.
Screening Guidelines
- The American Cancer Society guideline for the early detection of prostate cancer states that men who have at least a 10-year life expectancy should have an opportunity to make an informed/shared decision with their healthcare provider about whether to be screened for prostate cancer with serum PSA, with or without DRE 1.
- Asymptomatic men who have less than a 10-year life expectancy based on age and health status should not be offered prostate cancer screening 1.
Risk Assessment
- Factors that increase the risk of prostate cancer include African American race, a family history of prostate cancer, increasing age, an abnormal DRE, and age-specific PSA level 1.
- A prior negative biopsy lowers risk, and methods are available to estimate a man's overall risk of prostate cancer and his risk of high-grade prostate cancer, such as the Prostate Cancer Prevention Trial (PCPT) Prostate Cancer Risk Calculator 1.
Shared Decision-Making
- Patient decision aids are helpful in preparing men to make a decision whether to be tested, and clinicians should elicit patient preferences for screening during the shared decision-making process and document them in the medical record 1.
- Clinicians should help men judge the balance of benefits and harms and discuss whether the harms outweigh the potential reduction in prostate cancer mortality in their particular cases 1.
From the Research
Current Screening Protocol for Prostate Cancer
The current screening protocol for prostate cancer involves the use of prostate-specific antigen (PSA) testing, which is recommended for men between the ages of 50 and 69 as part of a shared decision-making process between the patient and their doctor 2. This process should include a discussion of the potential benefits and harms of screening, as well as the patient's individual risk factors and preferences.
Recommendations for Screening
The US Preventive Services Task Force (USPSTF) recommends that men aged 55 to 69 years should be informed about the benefits and harms of screening for prostate cancer, and offered PSA testing if they choose it 3, 4. For men aged 70 years and older, the USPSTF recommends against PSA-based screening for prostate cancer 3.
Factors to Consider in Screening Decisions
When deciding about screening, men should consider their individual risk factors, such as family history and race/ethnicity, as well as their personal values and preferences regarding the benefits and harms of screening and treatment-specific outcomes 3, 5. Men with a higher risk of prostate cancer, such as those with a family history or African American men, may benefit from more frequent screening 5.
Screening Frequency
The frequency of screening depends on the individual's age, family history, and risk factors. For men who choose to be screened, screening every other year is unlikely to cause a loss of sensitivity 5. The use of multiparametric MRI after a positive PSA result can reduce the number of biopsies and, consequently, the risk of overdiagnosis 2.
Benefits and Harms of Screening
The benefits of screening include a reduction in the risk of death from prostate cancer, as well as a reduction in the risk of metastatic prostate cancer 3. However, screening also carries potential harms, including false-positive results, overdiagnosis, and overtreatment, as well as treatment complications such as incontinence and erectile dysfunction 3, 6. Men should be informed about these benefits and harms and should make an individual decision about screening based on their personal values and preferences.
- Key benefits of screening:
- Reduction in risk of death from prostate cancer
- Reduction in risk of metastatic prostate cancer
- Key harms of screening:
- False-positive results
- Overdiagnosis
- Overtreatment
- Treatment complications (incontinence, erectile dysfunction)