What are the recommendations for prostate cancer screening?

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 the limited potential benefits and substantial harms of screening, as well as individual risk factors and patient preferences 1.

Key Considerations

• The primary screening test is the prostate-specific antigen (PSA) blood test, which may be performed annually or every 2-4 years depending on previous results and risk factors.
• Men at higher risk, including African American men and those with a family history of prostate cancer, should consider beginning screening at age 40-45.
• The digital rectal examination (DRE) may be performed alongside PSA testing, particularly for men with hypogonadism.
• Screening is generally not recommended for men under 40, over 70, or with less than a 10-year life expectancy due to other health conditions.

Benefits and Risks

• The benefit of screening is detecting cancer early when treatment is most effective, potentially reducing mortality.
• However, screening carries risks including false positives leading to unnecessary biopsies, overdiagnosis of slow-growing cancers that may never cause harm, and potential complications from subsequent treatments.
• A prior negative biopsy lowers risk, and methods are available to estimate a man's overall risk of prostate cancer and high-grade prostate cancer, such as the Prostate Cancer Prevention Trial (PCPT) Prostate Cancer Risk Calculator.

Guidance

• The American Cancer Society recommends that men who have at least a 10-year life expectancy should have an opportunity to make an informed/shared decision with their healthcare provider about whether to be tested for prostate cancer with serum PSA, with or without DRE, after receiving information about the benefits, risks, and uncertainties associated with prostate cancer screening 1.
• The U.S. Preventive Services Task Force recommends against PSA-based screening for prostate cancer in all age groups, citing the limited benefit and substantial harms of screening 1.
• The American College of Physicians recommends that clinicians inform men between the age 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, patient preferences, and general health and life expectancy 1.

From the Research

Prostate Cancer Screening Recommendations

The recommendations for prostate cancer screening are as follows:

• Prostate-specific antigen (PSA)-based screening has been shown to reduce metastasis and mortality in some studies 2
• However, the benefits of screening may take up to 10 years to accrue, and men with a life expectancy of less than 10-15 years may not benefit from screening 3
• The European Randomized Study of Screening for Prostate Cancer (ERSPC) reported a significant reduction in prostate cancer-specific mortality in men aged 55-69 years 3, 2
• The US Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial found no significant benefit of screening 3
• Screening can result in harms such as overdiagnosis, overtreatment, and treatment-related side effects 3, 2

Key Considerations

• Men should be informed of the potential benefits and harms of screening when deciding whether to undergo screening 3, 4
• The use of high-quality magnetic resonance imaging (MRI) can help reduce the need for digital rectal examination (DRE) and biopsy in active surveillance 5
• A dynamic, risk-adjusted approach to surveillance is a high research priority in active surveillance for prostate cancer 5

Age-Specific Recommendations

• Men aged 55-69 years may benefit from screening, as shown in the ERSPC study 3, 2
• Men aged 70 years and older may not benefit from screening, as shown in the ERSPC study 2
• Men with a life expectancy of less than 10-15 years may not benefit from screening 3