From the Guidelines
Men should stop PSA screening at the age of 69 years, as the harms of screening outweigh the benefits in men older than 69 years, according to the American College of Physicians guidance statement 1.
Key Considerations
- The U.S. Preventive Services Task Force also recommends against PSA-based screening for prostate cancer in all age groups, citing the potential harms of screening, including false positives, unnecessary biopsies, and overtreatment 1.
- The decision to stop PSA screening should be based on individual health factors and life expectancy, with men having at least a 10-year life expectancy potentially continuing screening 1.
- Men with significant health issues or limited life expectancy can consider stopping screening earlier, as the potential benefits of screening may not outweigh the harms in these cases.
- High-risk factors, such as family history or African American heritage, may influence the decision to continue screening beyond the recommended age guidelines.
Benefits and Harms of Screening
- The benefits of PSA screening include the potential reduction in prostate cancer mortality, with one study showing an absolute reduction in deaths due to prostate cancer in men between 55 and 69 years of age 1.
- However, the harms of screening are substantial and include false alarms, overdiagnosis, anxiety, and discomfort, as well as the potential risks associated with treatment, such as urinary, gastrointestinal, and sexual problems 1.
Guidance Statements
- The American College of Physicians recommends that clinicians inform men between the ages of 50 and 69 years about the limited potential benefits and substantial harms of screening for prostate cancer, and base the decision to screen on individual risk factors, health status, and patient preferences 1.
- Clinicians should not screen for prostate cancer in men who do not express a clear preference for screening, and should document patient preferences and discussions about the benefits and harms of screening in the medical record 1.
From the Research
Stopping Age for Prostate-Specific Antigen (PSA) Screening
- The optimal stopping age for PSA screening is not universally agreed upon, but several studies provide insights into this issue 2, 3, 4, 5.
- A study published in 2020 suggested that men aged 65 years and older with a PSA level of 0.5 ng/mL or lower may consider stopping screening, as their 10-year incidence of aggressive disease was low (0.25%) 4.
- Another study from 2006 found that PSA screening rates among elderly men with limited life expectancies were higher than expected, with 34% of men aged 85 years and older in best health and 36% in worst health undergoing a PSA test 5.
- The European Randomized Study of Screening for Prostate Cancer (ERSPC) reported a significant reduction in prostate cancer-specific mortality in men aged 55 to 69 years, but not in older men 3.
- A study from 2020 recommended limited PSA screening following informed consent in average-risk men aged 55-69 years, but did not provide a specific stopping age 2.
Factors Influencing Stopping Age
- Life expectancy is an important factor in determining the stopping age for PSA screening, as men with limited life expectancies are less likely to benefit from screening 3, 5.
- PSA level is also a consideration, as men with low PSA levels (e.g., 0.5 ng/mL or lower) may be able to stop screening at an earlier age 4.
- Race/ethnicity may also play a role, as black men with PSA levels of 1 ng/mL or lower had higher 10-year rates of aggressive disease compared to white men 4.