PSA Screening Frequency
For men who choose to undergo PSA screening after shared decision-making, check PSA every 1-2 years for those with PSA ≥1.0 ng/mL, and every 2-4 years for those with PSA <1.0 ng/mL. 1
Screening Intervals Based on PSA Level
Men with PSA <1.0 ng/mL:
- Screen every 2-4 years, as these men have minimal risk of developing advanced prostate cancer (only 0.23% at 4 years and 0.49% at 8 years). 1
- Extended intervals reduce unnecessary testing while maintaining mortality benefits. 1
- Men aged 45-49 with PSA ≤1.0 ng/mL can defer additional testing until age 50. 2
Men with PSA ≥1.0 ng/mL but <2.5 ng/mL:
- Screen every 1-2 years, as these men have higher risk of developing prostate cancer. 2, 1
- The NCCN uniformly recommends this interval for men with PSA >1.0 ng/mL. 2
Men with PSA ≥2.5 ng/mL:
- Screen annually according to the American Cancer Society. 2
- These men warrant more frequent monitoring due to elevated baseline risk. 2
Evidence Supporting Biennial vs. Annual Screening
The European ERSPC trial data demonstrates that biennial screening (every 2 years) provides comparable survival benefits to annual screening while significantly reducing harms: 2
- Biennial screening reduces overdiagnosis by approximately 13% compared to annual screening (2.4% vs 3.3%). 2
- It decreases total tests by 59% and false-positive results by 50%. 2
- The average delay in diagnosis when moving from annual to biennial screening is only 5-6 months. 1
However, screening every 2 years (compared to every 4 years) showed a 43% reduction in advanced prostate cancer diagnosis but also a 46% increase in low-risk prostate cancer diagnosis. 2
Age-Specific Considerations
Starting Age:
- Begin at age 45 for most men according to NCCN guidelines. 1
- Begin at age 40-45 for high-risk men (African American men, those with first-degree relatives diagnosed before age 65, or multiple family members with prostate cancer). 2, 1
- Average-risk men can begin at age 50 according to the American Cancer Society. 2
Stopping Age:
- Consider discontinuing routine screening at age 70 for most men. 1
- Very few men older than 75 benefit from PSA testing. 1
- Only screen men with at least 10-year life expectancy regardless of age. 2, 1
- For men over 70, individualize decisions based on health status and consider raising the PSA threshold for biopsy to reduce overdiagnosis. 1
Critical Caveats
Always engage in shared decision-making before initiating PSA screening, discussing potential benefits (small reduction in prostate cancer mortality) and harms (false-positives, overdiagnosis, treatment complications including erectile dysfunction and incontinence). 2, 1, 3
The US Preventive Services Task Force found that PSA screening in men aged 55-69 may prevent approximately 1.3 prostate cancer deaths per 1,000 men screened over 13 years, but causes significant harms including that 1 in 5 men undergoing radical prostatectomy develop long-term urinary incontinence and 2 in 3 experience long-term erectile dysfunction. 3
Baseline PSA in men in their 40s is a stronger predictor of future prostate cancer risk than family history or race alone, supporting the rationale for early baseline testing to guide future screening intervals. 1