From the Guidelines
Men with average risk of developing prostate cancer should begin screening discussions with their healthcare provider at age 50. The screening typically involves a prostate-specific antigen (PSA) blood test and possibly a digital rectal examination (DRE) 1. However, this recommendation isn't universal, as the decision to screen should be individualized based on a man's overall health, life expectancy, and personal preferences. The screening conversation should include a thorough discussion of potential benefits, such as early detection and treatment of aggressive cancers, as well as potential harms, including false positives leading to unnecessary biopsies, overdiagnosis, and treatment complications.
- Key factors to consider in the screening decision include:
- Age: Men at average risk should start discussions at age 50, while those at higher risk (e.g., African American men or those with a family history) may start earlier, around age 45 or even 40 for those with strong family history 1.
- Life expectancy: Asymptomatic men with less than a 10-year life expectancy should not be offered prostate cancer screening 1.
- Personal preferences: The decision to screen should be based on a shared decision-making process between the patient and healthcare provider, taking into account the patient's values and preferences 1. For men with higher risk factors, screening discussions may begin earlier, and the rationale for starting at age 50 for average-risk men is based on the increasing incidence of prostate cancer with age and the potential to detect clinically significant cancers while minimizing harms from overdiagnosis in younger men 1.
From the Research
Prostate Cancer Screening Age
The age at which to start screening for prostate cancer is a topic of debate, with various studies providing evidence on the benefits and harms of screening at different ages.
- For men with an average risk of developing prostate cancer, the US Preventive Services Task Force recommends screening with prostate-specific antigen (PSA) testing for men aged 55 to 69 years, as the net benefit of screening in this age group is small, but can help reduce the chance of death from prostate cancer 2.
- However, for men aged 70 years and older, the USPSTF recommends against PSA-based screening, as the potential benefits do not outweigh the expected harms 2.
- Other studies suggest that baseline PSA testing can be performed in men aged 40 to detect those at risk of aggressive prostate cancer, especially in high-risk populations such as African American men and men with a family history of prostate cancer 3.
- A single PSA measurement at or before age 50 has been shown to be a strong predictor of advanced prostate cancer diagnosed up to 25-30 years later, suggesting the possibility of using early PSA testing to risk-stratify patients 4, 5.
- A population-based cohort study found that PSA screening starting at age 50-54 years can decrease prostate cancer mortality, with a number needed to invite to screening and number needed to diagnose to prevent one prostate cancer death comparable to those reported for men aged 55-69 years 6.
Key Considerations
When considering the age at which to start screening for prostate cancer, the following factors should be taken into account:
- Family history of prostate cancer
- Race/ethnicity (African American men are at higher risk)
- Comorbid medical conditions
- Patient values and preferences regarding screening and treatment
- Potential benefits and harms of screening, including false-positive results, overdiagnosis, and treatment complications.