From the Guidelines
Prostate cancer screening with PSA should be initiated at age 50 for men at average risk, while men at higher risk, including African American men and those with a family history of prostate cancer, should start screening at age 45, and those with multiple first-degree relatives diagnosed with prostate cancer at an early age may consider screening as early as age 40.
Key Considerations
- The decision to screen should be individualized based on personal risk factors, overall health status, and life expectancy, as emphasized by the American Cancer Society guidelines 1.
- Men with a life expectancy of less than 10 years should not be offered prostate cancer screening, as the potential benefits do not outweigh the risks 1.
- The screening process involves a simple blood test measuring PSA levels, often performed alongside a digital rectal examination (DRE), and the frequency of screening can be extended to every 2 years for men with PSA levels less than 2.5 ng/mL 1.
Risk Stratification
- 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, and these factors should be taken into account when making decisions about screening and referral for biopsy 1.
- Risk calculators, such as the Prostate Cancer Prevention Trial (PCPT) Prostate Cancer Risk Calculator, can be used to estimate a man's overall risk of prostate cancer and his risk of high-grade prostate cancer, and to aid decisions about biopsy and other decisions 1.
Evidence-Based Recommendations
- The American Cancer Society guidelines recommend that men at average risk receive information about the benefits, risks, and uncertainties associated with prostate cancer screening starting at age 50, while men at higher risk should receive this information starting at age 45, and those with multiple first-degree relatives diagnosed with prostate cancer at an early age may consider screening as early as age 40 1.
- The guidelines also emphasize the importance of informed decision-making and shared decision-making between patients and healthcare providers, and the use of patient decision aids to prepare men to make a decision about whether to be tested 1.
From the Research
Prostate Cancer Screening Age
The age at which to initiate prostate cancer screening with Prostate-Specific Antigen (PSA) testing is a topic of discussion among medical professionals.
- Most guidelines recommend PSA screening to start no later than at age 55 for 'average-risk' men, with consideration of life expectancy (ranging from 7-15 years) 2, 3, 4, 5.
- For men at high risk, such as those of African descent or with a family history of prostate cancer, the earliest age for screening is 40 years, but recommendations often defer to clinical judgement 2, 5, 6.
- Some studies suggest starting conversations at age 45 for all men, or starting screening in early midlife for men with familial predisposition and men of African-American descent 5, 6.
- The US Preventive Services Task Force recommends against PSA-based screening for prostate cancer in men 70 years and older, and suggests that the decision to undergo periodic PSA-based screening for prostate cancer in men aged 55 to 69 years should be an individual one, including discussion of the potential benefits and harms of screening with their clinician 4.
Screening Intervals and Considerations
- Screening intervals can be risk-stratified, with longer intervals for those at lower risk and shorter intervals for those at higher risk 2, 5.
- Re-screening intervals, when specified, are biennial (most common), annual, or determined from baseline PSA 2.
- Overdiagnosis and unnecessary biopsies can be reduced using reflex tests, and magnetic resonance imaging in the pre-diagnostic setting holds promise in pilot studies 5.