What are the guidelines for Prostate-Specific Antigen (PSA) screening?

From the Guidelines

Prostate-Specific Antigen (PSA) screening is generally recommended for men aged 55-69 after a thorough discussion with their healthcare provider about potential benefits and harms, as stated in the most recent guidelines from the US Preventive Services Task Force, 2018 1. Men should have this informed decision-making conversation to determine if screening is right for them based on their individual risk factors and preferences. The standard screening involves a blood test measuring PSA levels, with readings below 4.0 ng/mL typically considered normal, though this can vary by age and other factors. For men who decide to undergo screening, it's usually performed every 1-2 years, with intervals based on initial and subsequent PSA levels, as recommended by the American Cancer Society, 2010 1. Some key points to consider include:

• Men with higher risk factors, including African American men and those with a family history of prostate cancer, may consider beginning screening earlier, around age 40-45, as suggested by the American Cancer Society, 2016, and the US National Comprehensive Cancer Network, 2018 1.
• Screening is generally not recommended for men under 40 or over 70, or those with less than a 10-year life expectancy, as stated by the US Preventive Services Task Force, 2018, and the European Association of Urology, 2018 1. The rationale behind these guidelines balances early detection benefits against potential harms of overdiagnosis and overtreatment, as many prostate cancers grow slowly and may never cause symptoms or require treatment during a man's lifetime, as discussed in the review of current American Cancer Society guidelines, 2018 1. Key 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, which should be considered in the individualized risk assessment, as recommended by the American Cancer Society, 2010 1. Overall, the decision to undergo PSA screening should be based on a thorough discussion of the potential benefits and harms, taking into account individual risk factors and preferences, as emphasized by the US Preventive Services Task Force, 2018, and the European Association of Urology, 2018 1.

From the Research

Guidelines for Prostate-Specific Antigen (PSA) Screening

• The US Preventive Services Task Force (USPSTF) recommends that men aged 55 to 69 years should discuss the potential benefits and harms of PSA-based screening for prostate cancer with their clinician, as the net benefit of screening is small for some men 2.
• For men aged 55 to 69 years, the decision to undergo periodic PSA-based screening should be an individual one, taking into account factors such as family history, race/ethnicity, comorbid medical conditions, and patient values 2.
• The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older, as the potential benefits do not outweigh the expected harms 2.
• Most guidelines state that men with a life expectancy of less than 10 years should not be screened, and that prior to PSA testing, men should be informed of the risks and benefits of the process 3.

Screening Practices

• Approximately 32.0% of men aged 40 years or older had a PSA test in the past two years, with 81.7% of these men having discussed the benefits and/or harms of PSA screening with a health professional 4.
• Most men having a PSA test have talked with a health professional about the test, but the talks tended to focus on just the benefits of screening and not both potential benefits and harms 4.
• Primary care physicians' use of the PSA test varies by patient risk category, with most physicians indicating that they generally discuss the possible benefits/risks of PSA testing with the patient and then recommend the test 5.
• PSA screening rates among elderly men with limited life expectancies are higher than recommended, with 56% of elderly men having a PSA test performed in 2003, despite guidelines advising against screening in this population 6.

Factors Influencing Screening Decisions

• Family history is an important factor in recommending PSA testing, with primary care physicians more likely to discuss and recommend the test for men with a family history of prostate cancer 5.
• Nonclinical factors, such as marital status and region of the country, can also influence PSA screening rates, with some subgroups of men in poor health having high screening rates 6.
• Patient values and preferences should be taken into account when making screening decisions, with clinicians considering the balance of benefits and harms on the basis of individual patient characteristics 2.