When to Stop PSA Screening for Prostate Cancer

PSA screening should be discontinued in men aged 70 years and older as the potential benefits do not outweigh the expected harms. 1, 2, 3

Age-Based Recommendations

The US Preventive Services Task Force (USPSTF) explicitly recommends against PSA-based screening for prostate cancer in men 70 years and older (Grade D recommendation) 1, 2, 3
Multiple guidelines, including those from the American College of Physicians and American Cancer Society, recommend against screening in men aged ≥70 years 1, 2
The National Comprehensive Cancer Network (NCCN) panel agrees that very few men older than 75 years benefit from PSA testing 1, 2

PSA screening should only be offered to men with a life expectancy of at least 10 years, regardless of age 2, 4
Men with significant comorbidities and reduced life expectancy are unlikely to benefit from PSA screening but still face all the potential harms 2, 5
A microsimulation model showed that decreasing the screening stopping age from 74 to 69 years would lead to a 27% reduction in lives saved but an almost 50% reduction in overdiagnosis 1, 2

For men aged 70-74 years who are very healthy with minimal comorbidities, PSA testing may be approached with caution 1, 2
If screening is continued in this age group, consider increasing the PSA threshold for biopsy to reduce overdiagnosis while maintaining cancer detection 1
The NCCN recommends that PSA testing be individualized after age 70 years and that indication for biopsy be carefully evaluated 1

Men aged 75 years or older with a PSA level less than 3.0 ng/mL are unlikely to die from prostate cancer and may safely discontinue screening 1, 2
In the Baltimore Longitudinal Study of Aging, no men aged 75-80 years with PSA less than 3.0 ng/mL died of prostate cancer 1
Men with PSA levels below median (<1 ng/mL) at age 60 have only a 0.5% risk of metastases and 0.2% risk of prostate cancer death 1, 2

Overdiagnosis is particularly problematic in older men, as many will harbor cancers that would never affect their life expectancy 1, 2, 3
Routine screening in men over 70 substantially increases rates of overdetection 1, 2
Potential harms of screening include frequent false-positive results, psychological harms, and complications from unnecessary biopsies 1, 3
Treatment complications include erectile dysfunction (affecting 2 in 3 men after radical prostatectomy), urinary incontinence (affecting 1 in 5 men), and bowel symptoms 3

For all men aged ≥70 years: Generally discontinue PSA screening 1, 2, 3
For men aged 70-74 years:
- If life expectancy <10 years: Discontinue screening 1, 2
- If very healthy with life expectancy >10 years: Consider continued screening with higher PSA threshold for biopsy 1
For men aged ≥75 years:
- If PSA <3.0 ng/mL: Discontinue screening 1, 2
- If previous PSA levels have been consistently low: Discontinue screening 1, 2

Continuing routine screening beyond age 70 without considering life expectancy 2, 5
Failing to recognize that the harms of screening increase with age while benefits decrease 1, 3
Not considering previous PSA values when making decisions about discontinuation 1
Screening men with limited life expectancy (<10 years) regardless of age 2, 5