PSA Screening Frequency in Average-Risk Men Over 50
For average-risk men over 50, check PSA every 2 years if the baseline PSA is ≥1.0 ng/mL, or every 2-4 years if PSA is <1.0 ng/mL. 1
Initial Screening Strategy
Begin baseline PSA testing at age 50 for average-risk men with at least 10 years of life expectancy. 2, 1 The strongest randomized trial evidence supports this approach, demonstrating 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 baseline PSA result, not a fixed annual schedule:
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 1
- Men in this category are at higher risk and warrant closer monitoring 2
For PSA <1.0 ng/mL:
- Repeat testing every 2-4 years 1, 4
- Men aged 60 with PSA <1 ng/mL have only 0.5% risk of metastases and 0.2% risk of prostate cancer death 1
- This extended interval safely reduces unnecessary testing in low-risk men 1
For PSA 1-2.5 ng/mL:
- Annual testing is recommended 1
For PSA ≥2.5 ng/mL:
- Further evaluation with biopsy should be considered 1
Evidence Supporting Biennial Screening
Biennial (every 2 years) screening provides comparable survival to annual screening while offering substantial advantages: 1
- 59% reduction in total tests performed
- 50% reduction in false-positive results
- Lower overdiagnosis rate (2.4% vs 3.3% for annual screening)
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
When to Stop Screening
Discontinue routine PSA screening at age 70 in most men. 1 Continue screening beyond age 70 only in very healthy men with minimal comorbidity, prior elevated PSA values, and life expectancy >10-15 years. 1 Randomized trials demonstrated mortality benefits only in men up to age 70. 1
Men aged 75 years or older with PSA <3.0 ng/mL are unlikely to die from prostate cancer and may safely discontinue screening. 1
Common Pitfalls to Avoid
- Don't use fixed annual screening intervals for all men. Risk-stratifying based on baseline PSA results prevents unnecessary testing and reduces false-positives. 1
- Don't continue screening in men over 70 with limited life expectancy. This increases harms without clear benefit. 1, 3
- Don't screen without shared decision-making. Discuss potential benefits (1.3 fewer deaths per 1,000 screened) versus harms (false-positives, overdiagnosis, treatment complications including erectile dysfunction in 2 of 3 men and urinary incontinence in 1 of 5 men after radical prostatectomy). 3
Why This Approach Works
A single PSA test predicts subsequent prostate cancer up to 30 years later with robust accuracy (AUC 0.72-0.75 for advanced cancer). 2, 5 Baseline PSA level is a stronger predictor of future prostate cancer risk than family history or race. 1, 4 This allows for personalized screening intervals that maximize benefit while minimizing overdiagnosis and unnecessary procedures.