From the Guidelines
Prostate-specific antigen (PSA) screening for prostate cancer is generally recommended to begin at age 50 for men at average risk, but men at higher risk, including African American men and those with a family history of prostate cancer, should consider starting earlier at age 45, as stated by the American Cancer Society in 2016 1.
Key Considerations
- Men with multiple first-degree relatives diagnosed with prostate cancer at an early age may begin screening as early as age 40, according to the American Cancer Society guidelines 1.
- The US Preventive Services Task Force recommends providing information about potential benefits and harms of screening for men aged 55-69 years and recommends against screening for men aged ≥70 years, as stated in their 2018 guidelines 1.
- The decision to screen should be a personalized one, discussed with a healthcare provider, taking into account individual risk factors, health status, and life expectancy.
Screening Approach
- The PSA test measures a protein produced by the prostate gland, with levels above 4.0 ng/mL often prompting further evaluation, though this threshold may vary based on age and other factors.
- Screening intervals can be extended to every 2 years for men with PSA levels less than 2.5 ng/mL, and screening should be conducted yearly for men with PSA levels of 2.5 ng/mL or higher, as recommended by the American Cancer Society 1.
Risk Assessment
- Factors that increase the risk of prostate cancer include African American race, a family history of prostate cancer, increasing age, an abnormal DRE, and age-specific PSA level, as noted in the American Cancer Society guidelines 1.
- Risk assessment tools, such as the Prostate Cancer Prevention Trial (PCPT) Prostate Cancer Risk Calculator, can help estimate a man's overall risk of prostate cancer and guide screening decisions, as described by the American Cancer Society 1.
From the Research
Age for PSA Screening
- The recommended age for PSA screening varies, but most guidelines suggest starting at age 50-55 for 'average-risk' men and considering life expectancy [(2,3)].
- For high-risk men, such as those of African descent or with a family history of prostate cancer, screening may start as early as 40 years old 2.
- Some studies suggest starting conversations about PSA screening at age 45 for all men 3.
- The US Preventive Services Task Force recommends PSA screening for men aged 55-69, based on a personal decision following consultation with a health professional 4.
Factors Influencing Screening Age
- Life expectancy is an important factor in determining the age for PSA screening, with most guidelines recommending screening for men with a life expectancy of at least 10-15 years [(2,3)].
- Family history and ethnicity may also influence the age for screening, with high-risk men potentially starting screening earlier [(2,3)].
- The age at which to start PSA screening remains uncertain, but starting at a younger age may be associated with a greater reduction in prostate cancer mortality 5.
Screening Intervals and Methods
- Screening intervals can be risk-stratified, with longer intervals for those at lower risk and shorter intervals for those at higher risk 3.
- PSA testing can be used in conjunction with digital rectal examination to enhance early prostate cancer detection 6.
- The use of reflex tests and magnetic resonance imaging may help reduce overdiagnosis and unnecessary biopsies 3.