From the Guidelines
Prostate cancer screening is recommended for men aged 55 to 69 years through a shared decision-making process with their healthcare provider, taking into account individual risk factors and values. The primary screening test is the prostate-specific antigen (PSA) blood test, typically performed every 1-2 years 1. Men with higher risk factors, including African American men and those with a family history of prostate cancer, should consider beginning screening earlier, around age 40-45 1. The digital rectal examination (DRE) may also be used as a complementary screening method.
Some key points to consider when making a decision about prostate cancer screening include:
- The benefits of screening, including the potential to detect cancer early and reduce mortality
- The risks of screening, including false positives, overdiagnosis, and potential complications from subsequent treatments
- Individual risk factors, such as family history and African American race
- Personal values and preferences regarding screening and treatment
The American College of Physicians (ACP) recommends that clinicians inform men between the ages of 50 and 69 about the limited potential benefits and substantial harms of screening for prostate cancer, and base the decision to screen on the risk for prostate cancer, a discussion of the benefits and harms of screening, the patient's general health and life expectancy, and patient preferences 1. The ACP also recommends against screening for prostate cancer in average-risk men under the age of 50, men over the age of 69, or men with a life expectancy of less than 10 to 15 years 1.
It's worth noting that the evidence on prostate cancer screening is mixed, with some studies showing a benefit to screening and others showing no benefit or even harm 1. However, the most recent and highest-quality studies suggest that screening can be beneficial for men aged 55 to 69, but that the decision to screen should be individualized based on personal values, risk factors, and overall health status.
From the Research
Prostate Cancer Screening Recommendations
- The US Preventive Services Task Force recommends that prostate-specific antigen (PSA) screening for prostate cancer involve men aged 55-69, based on a personal decision following consultation with a health professional 2, 3.
- For men aged 70 or older, PSA screening should only occur if symptoms exist 2, 3.
- Most guidelines recommend screening every 2 to 4 years in men 55 to 69 years of age at average risk 4.
- Shared decision-making is strongly recommended by all national guidelines before initiating screening 4, 5, 6.
- The primary intent of screening is to identify patients with clinically significant prostate cancer who may benefit from curative treatment while minimizing the detection of clinically insignificant cancer 4.
Screening Frequency and Target Population
- Routine PSA screening rates remained stable from 2015 to 2018, with no significant increase in PSA-based prostate cancer screening 6.
- The increase in shared decision-making was most prominent in men aged 55 to 69 years 6.
- African American men and men with a family history of prostate cancer have an increased risk of prostate cancer compared with other men 3.
Harms and Benefits of Screening
- Potential harms of screening include frequent false-positive results and psychological harms 4, 3.
- Harms of prostate cancer treatment include erectile dysfunction, urinary incontinence, and bowel symptoms 3.
- Screening programs may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened, and prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened 3.