What is the recommended interval for the next PSA test for a 43-year-old male with ED and a normal PSA level of 0.37 ng/mL?

PSA Testing Interval for a 43-Year-Old Male with ED and Normal PSA

For a 43-year-old male with erectile dysfunction and a normal PSA level of 0.37 ng/mL, PSA testing should be repeated in 2-4 years.

Rationale for Recommendation

The patient's current PSA level of 0.37 ng/mL is well below concerning thresholds, which guides the appropriate screening interval:

• According to NCCN guidelines, men with PSA levels less than 1 ng/mL can safely extend their testing interval to every 2-4 years 1
• This recommendation is supported by evidence showing that men with very low PSA levels have minimal risk of developing clinically significant prostate cancer within 2-4 years 1
• The patient's young age (43) and very low PSA (0.37 ng/mL) place him in a low-risk category

Evidence Supporting Extended Interval Testing

Multiple guidelines support extended screening intervals for men with low PSA values:

• The NCCN recommends repeat testing every 2-4 years if PSA is less than 1 ng/mL for men aged 45-75 years 1
• The American Cancer Society recommends that men with PSA levels below 2.5 ng/mL can reduce their screening frequency to every 2 years 1
• Data from the PLCO trial showed that among men with initial PSA level of 1.0 ng/mL, only 0.24% had a positive test (PSA >4 ng/mL) the following year, and only 0.51% had a positive test 2 years later 1

Risk Assessment Based on Current PSA

The patient's current PSA of 0.37 ng/mL indicates very low risk:

• Studies show that men with PSA levels below 1.0 ng/mL have only a 0.51% risk of developing prostate cancer over a 4-year period 2
• The PLCO trial demonstrated that no men with PSA ≤1 ng/mL died from prostate cancer within 5 years 3
• The Rotterdam section of the ERSPC trial found that men with PSA less than 1 ng/mL had only a 0.23% risk for cancer at 4 years and 0.49% at 8 years 1

Age-Specific Considerations

While the patient is younger than the typical age when routine PSA screening begins:

• At 43 years old, he falls below the recommended age for routine screening (45-50 years) 1
• However, since he already has a baseline PSA and has erectile dysfunction, continued monitoring is appropriate
• His very low PSA (0.37 ng/mL) suggests minimal risk in the short term

Clinical Considerations for ED and PSA

The presence of erectile dysfunction should be considered in PSA interpretation:

• ED can be associated with prostatic inflammation, which might affect PSA levels 4
• However, the patient's current PSA is very low, suggesting minimal inflammation
• Tadalafil (which the patient uses for ED) does not significantly alter PSA levels

Practical Recommendation

Based on the evidence and the patient's specific characteristics:

• Repeat PSA testing in 2-4 years is appropriate given his very low PSA level
• The closer to 2 years would be more conservative given his young age (43)
• If future PSA rises to ≥1.0 ng/mL, testing frequency should increase to every 1-2 years 1

Important Caveats

• If the patient develops urinary symptoms, family history of prostate cancer, or other risk factors, earlier testing may be warranted
• African American men have higher risk at equivalent PSA levels and may need more frequent testing 5, though the patient's race was not specified
• PSA velocity (rate of change) should be monitored in future tests, as increases >0.35-0.4 ng/mL per year may warrant further evaluation 5