At what age does Prostate-Specific Antigen (PSA) screening typically start?

From the Guidelines

Prostate-Specific Antigen (PSA) screening typically starts at age 50 for men at average risk of prostate cancer, but may begin earlier at age 45 or 40 for those at higher risk, including African American men and those with a family history of prostate cancer. The decision to start screening should be based on a shared decision-making approach between the patient and their healthcare provider, taking into account the potential benefits and limitations of testing 1. This approach is important because while PSA screening can help detect prostate cancer early, it may also lead to unnecessary procedures for slow-growing cancers that might never cause symptoms.

Key Considerations

• Men at average risk should receive information about PSA screening starting at age 50 years, while those at higher risk, such as African American men or men with a family history of prostate cancer, should receive this information starting at age 45 years 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.
• The recommendation for when to stop screening varies, but many guidelines suggest discontinuing routine screening after age 70 or when life expectancy is less than 10 years 1.

Factors Influencing Screening Decisions

• Age: Screening typically starts at age 50 for average-risk men, but may begin earlier for those at higher risk.
• Family history: Men with a family history of prostate cancer, especially in a father or brother, are at higher risk and may need to start screening earlier.
• Race: African American men are at higher risk for prostate cancer and may need to start screening earlier.
• Life expectancy: Screening is generally not recommended for men with a life expectancy of less than 10 years.

Importance of Shared Decision-Making

• The decision to start PSA screening should be based on a shared decision-making approach between the patient and their healthcare provider, taking into account the potential benefits and limitations of testing.
• Patient decision aids can be helpful in preparing men to make a decision about whether to be tested.

From the Research

Prostate-Specific Antigen (PSA) Screening Age

• The age at which PSA screening typically starts is a topic of discussion among healthcare professionals and researchers.
• According to the US Preventive Services Task Force (USPSTF) recommendation statement 2, PSA-based screening for prostate cancer is recommended for men aged 55 to 69 years who express a preference for being screened after being informed about and understanding PSA test benefits and risks.
• However, some studies suggest that screening may be beneficial for men starting at age 50-54 years 3.
• A population-based cohort study found that regular PSA-screening in men in their early 50s carried a more than two-fold higher risk of prostate cancer diagnosis, but resulted in a substantial decrease in the risk of metastases and prostate cancer death 3.
• Another study found that PSA screening prevalence increased with increasing age groups, with 27.2% of men aged 55 to 69 years and 33.7% of men aged 70 years and older undergoing PSA screening in the prior year 4.
• Despite the USPSTF guidelines advising against PSA screening for prostate cancer in males older than 69 years, low-value PSA screening in males aged 70 years or older remains common 5.

Factors Associated with Low-Value PSA Screening

• Discussing PSA testing advantages with a clinician was associated with increased recent screening 5.
• Having a primary care physician, a post-high school educational level, and income of more than $25,000 per year were also associated with a higher screening rate 5.
• Non-Hispanic White males had the highest screening rate, while non-Hispanic American Indian males had the lowest screening rate 5.

Screening Recommendations

• The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older 2.
• For men aged 55 to 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 2.