PSA Screening Frequency for Men Over 50
For average-risk men over 50, check PSA every 1-2 years, with the option to extend to every 2-4 years if PSA remains below 1.0 ng/mL. 1
Initial Screening Strategy
The National Comprehensive Cancer Network uniformly recommends baseline PSA testing for healthy, well-informed men aged 50-70 years with at least 10 years life expectancy. 2 This recommendation is supported by the strongest randomized trial evidence showing approximately 1.3 fewer prostate cancer deaths per 1,000 men screened over 13 years. 1, 3
Risk-Stratified Screening Intervals
The frequency of PSA testing should be determined by your initial PSA result rather than using fixed annual intervals for everyone:
For PSA ≥1.0 ng/mL:
- Repeat testing every 1-2 years 2, 1
- This interval balances cancer detection with reduced overdiagnosis compared to annual screening 2
- Screening every 2 years reduces advanced prostate cancer diagnosis by 43% compared to every 4 years, though it does increase low-risk cancer detection by 46% 1
For PSA <1.0 ng/mL:
- Repeat testing every 2-4 years 1, 4
- Men aged 60 with PSA <1.0 ng/mL have only 0.5% risk of metastases and 0.2% risk of prostate cancer death, supporting longer screening intervals 1, 4
Evidence Supporting Biennial Screening
Microsimulation models demonstrate that biennial screening in men with average PSA levels provides comparable survival to annual screening while achieving: 2
- 59% reduction in total tests
- 50% reduction in false-positive results
- Lower overdiagnosis rate (2.4% vs 3.3% for annual screening)
The European Randomized Study of Screening for Prostate Cancer (ERSPC) trial directly compared screening intervals, showing that 2-year intervals significantly reduced advanced cancer diagnoses compared to 4-year intervals. 2
When to Stop Screening
Discontinue routine PSA screening at age 70 in most men. 1, 4 Continue beyond age 70 only in very healthy men with minimal comorbidity, prior elevated PSA values, and life expectancy >10-15 years. 1, 4 The USPSTF recommends against PSA screening in men 70 years and older, as potential benefits do not outweigh expected harms. 1, 3
Men aged 75 years or older with PSA <3.0 ng/mL are unlikely to die from prostate cancer and may safely discontinue screening. 2, 1
Critical Monitoring Triggers
Regardless of your routine screening interval, consider prostate biopsy if PSA increases by ≥1.0 ng/mL in any 12-month period, regardless of absolute PSA value. 4, 5 If PSA rises by 0.7-0.9 ng/mL in one year, repeat measurement in 3-6 months and perform biopsy if there is any further increase. 4
Common Pitfalls to Avoid
- Don't use fixed annual screening for all men – this leads to unnecessary testing and false-positives in low-risk individuals 1
- Don't test within 48 hours of ejaculation – this causes false-positive elevations 5
- Don't act on a single elevated PSA – 40-44% of initially elevated values normalize on repeat testing 5
- Don't continue screening in men with limited life expectancy – screening men with <10 years life expectancy provides no benefit and only causes harm 1