At what age should Prostate-Specific Antigen (PSA) screening begin?

From the Guidelines

Prostate-specific antigen (PSA) screening should begin at age 45 for most men, with earlier screening at age 40 for high-risk individuals, including African American men and those with a family history of prostate cancer. The screening typically involves a blood test measuring PSA levels, with follow-up determined by results. For men with PSA levels under 1 ng/mL, rescreening every 2-4 years is appropriate, while those with higher levels may need annual screening. PSA screening should generally be discontinued at age 70 or when life expectancy is less than 10 years. This approach balances early detection benefits with avoiding overdiagnosis and unnecessary treatment. PSA screening can detect prostate cancer before symptoms develop, potentially allowing for more effective treatment, though it's essential to note that elevated PSA levels can also result from non-cancerous conditions like prostatitis or benign prostatic hyperplasia. The decision to undergo screening should involve a discussion with your healthcare provider about personal risk factors and preferences, as recommended by the American Cancer Society 1.

Key Considerations

• The American Cancer Society recommends that men at average risk should receive information about PSA screening beginning at age 50 years, and black men or men with a family history of prostate cancer should receive information at age 45 years 1.
• The US Preventive Services Task Force (USPSTF) recommends against PSA-based screening for prostate cancer in all age groups, citing the potential harms of overdiagnosis and overtreatment 1.
• However, the most recent and highest-quality study from the American Cancer Society 1 suggests that informed decision-making and individualized screening approaches are crucial for balancing the benefits and harms of PSA screening.

Screening Approach

• PSA screening should be individualized based on a man's risk factors, preferences, and life expectancy.
• Men with a family history of prostate cancer or African American men should be considered for earlier screening, starting at age 40 or 45, respectively.
• The screening interval should be determined by the initial PSA level, with men having lower PSA levels potentially screened less frequently.

Discontinuation of Screening

• PSA screening should generally be discontinued at age 70 or when life expectancy is less than 10 years, as the potential benefits of screening may be outweighed by the harms of overdiagnosis and overtreatment in these populations.

From the Research

Age for Prostate-Specific Antigen (PSA) Screening

The recommended age for starting PSA screening varies among different guidelines and studies.

• Most guidelines recommend PSA screening to start no later than at age 55 for men in good health and with a life expectancy of at least 10-15 years 2, 3, 4, 5.
• Some studies suggest starting screening in early midlife for men with familial predisposition and men of African-American descent 3.
• Others suggest starting conversations at age 45 for all men 3.
• The US Preventive Services Task Force recommends that PSA screening for prostate cancer involve men aged 55-69, based on a personal decision following consultation with a health professional 2, 5.
• For men aged 70 or older, the US Preventive Services Task Force recommends against PSA-based screening for prostate cancer, as the potential benefits do not outweigh the expected harms 5.

Screening Intervals and High-Risk Men

• Screening intervals can be risk-stratified as guided by the man's age, general health, and PSA-value; longer intervals for those at lower risk and shorter intervals for those at higher risk 3.
• The recommended age for screening high-risk men (frequently defined as of African descent or with a family history of prostate cancer) is 40 years, but recommendations often defer to clinical judgement 6.
• Guidelines emphasize shared patient-clinician decision making, and the development of clinical decision aids and international consensus on guidelines may help reduce national and international variation on how men are counselled 6.

Shared Decision Making

• Shared decision-making is strongly recommended by all national guidelines before initiating screening 4, 5.
• The decision to undergo periodic PSA-based screening for prostate cancer should be an individual one and should include discussion of the potential benefits and harms of screening with their clinician 5.