What are the recommendations for prostate cancer screening in men?

From the Guidelines

Prostate cancer screening is recommended for men aged 55-69 years, with the decision to screen made through shared decision-making between the patient and provider, taking into account the potential benefits and harms of screening, as well as the patient's individual risk factors and preferences 1. The primary screening methods include the prostate-specific antigen (PSA) blood test and digital rectal examination (DRE).

• For men whose PSA is less than 2.5 ng/mL, screening intervals can be extended to every 2 years, and screening should be conducted yearly for men whose PSA level is 2.5 ng/mL or higher 1.
• A PSA level of 4.0 ng/mL or higher has historically been used to recommend referral for further evaluation or biopsy, which remains a reasonable approach for men at average risk for prostate cancer 1. Key considerations in prostate cancer screening include:
• The potential benefits of early detection, including reduced mortality from prostate cancer
• The potential harms of screening, including false positives, unnecessary biopsies, and treatment of slow-growing cancers that might never cause symptoms
• The importance of individualized decision-making, taking into account the patient's age, risk factors, and preferences
• The need for ongoing research to better understand the benefits and harms of prostate cancer screening and to develop more effective screening strategies. It is essential to weigh the potential benefits of screening against the potential harms, including overdiagnosis and overtreatment, and to consider the patient's individual risk factors and preferences when making decisions about screening 1. Men at higher risk, such as African American men or those with a family history of prostate cancer, may need to start screening earlier, at age 45, and may need more frequent screening 1. Ultimately, the decision to screen for prostate cancer should be made on an individual basis, taking into account the patient's unique circumstances and preferences, and in consultation with a healthcare provider.

From the Research

Prostate Cancer Screening Recommendations

The recommendations for prostate cancer screening in men vary depending on age and risk factors.

• For men aged 55 to 69 years, most guidelines recommend screening every 2 to 4 years, with shared decision-making strongly recommended before initiating screening 2, 3.
• 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 prostate-specific antigen (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, as the potential benefits do not outweigh the expected harms 3.

Screening Intervals and Methods

• The screening interval for men aged 55 to 69 years is typically every 2 to 4 years, with some studies suggesting biennial screening to mitigate the potential harms of screening 5.
• The PSA test is the most commonly used screening method, with a threshold of 4 ng/mL used to determine the need for further testing 2.
• After a positive PSA test result, next steps include multiparametric magnetic resonance imaging, assessment of urine or blood biomarkers, and referral to urology 2.

Risk Factors and Special Considerations

• Risk factors for prostate cancer include older age, family history of prostate cancer, and Black race 2, 3.
• African American men and men with a family history of prostate cancer have an increased risk of prostate cancer compared with other men, and may benefit from more frequent screening 3.
• Active surveillance is increasingly accepted as the preferred standard of care for patients with newly diagnosed low-risk prostate cancer, as it is associated with similar long-term survival and better quality of life than curative treatment 2.