When to Stop PSA Screening
For average-risk men, discontinue routine PSA screening at age 70, with rare exceptions only for exceptionally healthy men with minimal comorbidity, prior elevated PSA values, and life expectancy exceeding 10-15 years. 1, 2, 3
Age-Based Stopping Guidelines
Standard Stopping Age (Age 70)
- The NCCN uniformly recommends individualizing PSA testing after age 70, with testing performed only with caution in very healthy men with little or no comorbidity 1
- The strongest evidence from randomized trials demonstrates screening benefits only in men up to age 70 3
- Most guideline organizations converge on age 70 as the upper limit for routine screening 2, 3, 4
Age 75 and Beyond
- The USPSTF explicitly recommends against PSA-based screening in men 70 years and older, citing that harms outweigh benefits due to increased false-positives, biopsy complications, and treatment-related morbidity 5
- The NCCN panel agreed that very few men older than 75 years benefit from PSA testing 1
- Men aged 75 years or older with PSA <3.0 ng/mL are unlikely to die from prostate cancer (0.2% risk) and may safely discontinue screening 1, 3
Risk-Stratified Approach to Stopping
PSA-Based Decision Making
- For men aged 60 with PSA <1 ng/mL: only 0.5% risk of metastases and 0.2% risk of prostate cancer death—screening can safely stop 1, 3
- For men aged 75-80 with PSA <3.0 ng/mL: time to death or aggressive prostate cancer diagnosis is sufficiently long that these men are unlikely to experience clinically significant disease 1
- Men with PSA ≥3.0 ng/mL at age 70-75 may warrant continued surveillance if otherwise healthy with >10-year life expectancy 1, 6
Life Expectancy Considerations
- Only continue screening beyond age 70 if life expectancy clearly exceeds 10-15 years 2, 3, 6
- Men with significant comorbidities limiting life expectancy to <10 years should discontinue screening regardless of age 6
- The median age of death from prostate cancer is 80 years, and 75% of men with localized prostate cancer die of other causes rather than prostate cancer 1, 5
Evidence Supporting Earlier Cessation
Competing Mortality Risks
- At older ages, competing mortality risks eventually dominate prostate cancer risk, making harms exceed benefits 4
- Analysis from multiple perspectives (patient, healthcare system, social) consistently identifies ages 68-70 as optimal stopping points 4
- In men aged 66-69 at diagnosis with well- or moderately differentiated tumors, 10-year mortality from other causes (0-22%) far exceeds prostate cancer mortality (0-7%) 1
Overdiagnosis Burden
- Routine screening in men >70 years substantially increases overdetection rates, as a large proportion harbor indolent cancers unlikely to affect life expectancy 1, 6
- Approximately 1 in 5 men undergoing radical prostatectomy develop long-term urinary incontinence, and 2 in 3 experience long-term erectile dysfunction—harms that disproportionately affect older men 5
Common Pitfalls to Avoid
- Continuing routine annual screening beyond age 70 without reassessing health status and prior PSA trajectory 2, 3
- Screening men with <10-year life expectancy provides no benefit and only causes harm through unnecessary biopsies and treatment complications 6
- Using a strict age cutoff of 75 without considering PSA values may miss the small subset of healthy older men with elevated PSA who could benefit from continued surveillance 1, 7
- Failing to recognize that higher PSA thresholds in elderly men (>4 ng/mL) do not effectively identify those at greater risk—age itself is a significant factor for clinically significant cancer even when controlling for PSA 8
Algorithm for Decision-Making
**Age <70:** Continue screening if life expectancy >10 years 1, 2
Age 70-74:
- PSA <3.0 ng/mL + average health → Stop screening 1, 3
- PSA ≥3.0 ng/mL + excellent health + no comorbidity → Consider continuing with increased biopsy threshold 1
Age ≥75: