From the Guidelines
Prostate-specific antigen (PSA) screening should begin at age 50 for men at average risk, but for those at higher risk, including African American men and men with a family history of prostate cancer, screening should start at age 45, and for men at appreciably higher risk, screening should begin at age 40. This recommendation is based on the American Cancer Society guidelines, as outlined in the study published in 2018 1. The guidelines emphasize the importance of informed decision-making, where men should receive information about the benefits, risks, and uncertainties associated with prostate cancer screening.
Key Considerations
- Men at average risk should receive this information beginning at age 50 years.
- Men at higher risk, including African American men and men with a family member (father or brother) diagnosed with prostate cancer before age 65 years, should receive this information beginning at age 45 years.
- Men at appreciably higher risk (multiple family members diagnosed with prostate cancer before age 65 years) should receive this information beginning at age 40 years.
Screening Process
The screening process involves a PSA test, with or without a digital rectal exam (DRE), and the frequency of screening depends on the PSA level, with men having PSA levels less than 2.5 ng/mL screened every 2 years, and those with PSA levels of 2.5 ng/mL or higher screened yearly 1. It is crucial for men to discuss the potential benefits and harms of PSA screening with their healthcare provider before starting the screening process.
From the Research
When to Start Checking PSA
- The American Urological Association recommends that men between 55 and 69 years old discuss the benefits and risks of prostate-specific antigen (PSA) screening with their doctor 2.
- Some studies suggest that men with a family history of prostate cancer or other risk factors may need to start screening earlier, at age 40 or 45 3.
- However, there is no consensus on the exact age to start checking PSA, and the decision should be individualized based on a man's risk factors and medical history.
Factors to Consider
- Digital rectal examination (DRE) is often used in conjunction with PSA screening, but its role is being reevaluated in light of new evidence 4, 5.
- Studies have shown that DRE can increase PSA levels, which may lead to unnecessary biopsies or further testing 4, 6.
- The use of MRI as a screening tool is being explored, and some studies suggest it may be more accurate than DRE in identifying clinically significant prostate cancer 5.
Screening Guidelines
- The US Preventive Services Task Force recommends that men between 55 and 69 years old discuss the benefits and risks of PSA screening with their doctor, and that screening should be individualized based on a man's risk factors and medical history.
- The American Cancer Society recommends that men with a family history of prostate cancer or other risk factors should discuss screening options with their doctor at age 40 or 45.
- It is essential to consult with a healthcare professional to determine the best screening approach based on individual circumstances 2, 3.