What are the guidelines for prostate screening in men?

From the Guidelines

Prostate cancer screening guidelines recommend that men discuss the benefits and risks of screening with their healthcare provider before making a decision, with discussions starting at age 50 for average-risk men and earlier for those at higher risk, such as African American men and those with a family history of prostate cancer. The primary screening methods include the prostate-specific antigen (PSA) blood test and digital rectal examination (DRE) 1. If screening is chosen, it typically occurs every 1-2 years, with PSA levels under 4 ng/mL generally considered normal, though this can vary by age and other factors. The benefit of screening is early detection of cancer when treatment may be more effective, but potential harms include false positives leading to unnecessary biopsies, overdiagnosis of slow-growing cancers, and treatment complications like incontinence and erectile dysfunction. For men over 70 or with less than 10-15 years life expectancy, routine screening is generally not recommended as the potential harms often outweigh the benefits, as supported by guidelines from the US Preventive Services Task Force and other organizations 1. This individualized approach to screening acknowledges that prostate cancer varies widely in aggressiveness, and not all detected cancers require immediate treatment. Key considerations include:

• The potential benefits and harms of screening, including the risk of false positives and overdiagnosis
• The individual's risk factors, such as family history and ethnicity
• The individual's overall health and life expectancy
• The importance of shared decision-making between the patient and healthcare provider
• The need for ongoing evaluation and monitoring of screening guidelines and recommendations.

From the Research

Guidelines for Prostate Screening

The guidelines for prostate screening in men are as follows:

• The US Preventive Services Task Force (USPSTF) recommends that men aged 55 to 69 years discuss the potential benefits and harms of prostate-specific antigen (PSA)-based screening for prostate cancer with their clinician 2.
• The USPSTF concludes that the net benefit of PSA-based screening for prostate cancer in men aged 55 to 69 years is small, and the decision to undergo screening should be an individual one 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.

Factors Influencing Prostate Screening Decisions

Several factors influence prostate screening decisions, including:

• Health care provider (HCP) recommendation: an HCP recommendation is a strong predictor of testing decisions 3.
• Patient values and preferences: men's preferences for PSA screening are influenced by test characteristics, such as potential mortality benefit and unnecessary biopsies 4.
• Age: men's preferences for PSA screening vary by age, with older men being less likely to prioritize screening 4.
• Prior PSA testing experience: men who have had prior PSA testing experience are more likely to prioritize screening 4.
• Perceived risk of prostate cancer: men who perceive themselves to be at higher risk of prostate cancer are more likely to prioritize screening 4.

Informed Decision-Making for Prostate Screening

Informed decision-making for prostate screening is critical, and several studies have highlighted the need for improved patient education and physician communication:

• A survey of men aged 50 and above found that screening rates were high, but many men did not receive comprehensive information about the benefits and harms of screening 5.
• A study of urban African American men found that only 13% of men reported receiving a comprehensive explanation of the pros and cons of prostate cancer screening tests 6.
• Men who received a comprehensive explanation of the pros and cons of screening were more likely to have higher prostate cancer knowledge and more positive screening attitudes 6.