From the Guidelines
Annual PSA screenings should not be routinely performed for all men, as the harms of screening, including overdiagnosis and overtreatment, may outweigh the benefits for most men. The decision to screen for prostate cancer using the prostate-specific antigen (PSA) test should be based on a discussion of the benefits and harms of screening, the patient's general health and life expectancy, and patient preferences 1. Men between the ages of 50 and 69 years should be informed about the limited potential benefits and substantial harms of screening for prostate cancer, and the decision to screen should be individualized based on a man's risk factors, overall health status, life expectancy, and personal preferences regarding the potential outcomes of screening, diagnosis, and treatment.
- Key considerations include:
- The potential benefits of screening, including the reduction of deaths from prostate cancer, which was found to be limited to men between the ages of 55 and 69 years in the ERSPC study 1
- The substantial harms of screening, including false-positive results, overdiagnosis, overtreatment, and the downstream harms and costs associated with overtreatment 1
- The importance of shared decision-making in making choices about prostate cancer screening, including discussing the benefits and harms of screening, the patient's general health and life expectancy, and patient preferences 1
- The lack of clear evidence to guide decisions about the periodicity or frequency of the evaluation of risk for prostate cancer or discussion about the benefits and harms, although increasing the interval between screening tests may reduce harms 1
- Specific guidance statements include:
- The American College of Physicians (ACP) 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 that clinicians should not screen for prostate cancer using the PSA test in patients who do not express a clear preference for screening 1
- The ACP recommends that clinicians should not screen for prostate cancer using the PSA test in average-risk men under the age of 50 years, men over the age of 69 years, or men with a life expectancy of less than 10 to 15 years 1
From the Research
Annual PSA Screenings
- The decision to undergo annual PSA screenings is a complex one, with various factors to consider, including age, risk level, and potential benefits and harms 2, 3, 4.
- Some studies suggest that annual PSA screenings can be beneficial in reducing prostate cancer mortality, particularly for men aged 55-75 years 3.
- However, other studies emphasize the importance of shared patient-clinician decision making and highlight the potential harms of overdiagnosis and overtreatment 2, 4.
- The US Preventive Services Task Force (USPSTF) has revised its guidelines to endorse individual decision-making for men aged 55 to 69 years, which has led to an increase in PSA testing rates 5.
Age and Risk Level Considerations
- For men at average risk, the recommended age for starting PSA screenings varies from 50-55 to 70 years, with consideration of life expectancy 2.
- High-risk men, such as those of African descent or with a family history of prostate cancer, may benefit from earlier screening, starting at age 40 2, 4.
- However, screening recommendations for older men (aged 70-89 years) are less clear, and the benefits of screening may be outweighed by the potential harms 4, 5.
Screening Intervals and Detection Rates
- The optimal screening interval is not well established, with some studies suggesting annual or biennial screenings 2, 3.
- The detection rate of prostate cancer varies depending on the screening interval and age group, with higher detection rates for men aged 55-75 years 3.
- Digital rectal examination (DRE) can also be used in conjunction with PSA testing to detect prostate cancer, particularly in men with low serum PSA levels 6.