PSA and Colonoscopy Screening: Upper Age Limits
Stop routine PSA screening at age 70 for most men, and discontinue colonoscopy screening at age 75 for average-risk individuals.
PSA Screening: When to Stop
Standard Stopping Age
- Discontinue routine PSA screening at age 70 for the majority of men, as randomized trial evidence demonstrating mortality benefit extends only up to this age. 1, 2
- The USPSTF and American College of Physicians both recommend against PSA screening in men aged 70 years and older. 2
Selective Continuation Beyond Age 70
- Continue screening beyond age 70 only in exceptionally healthy men who meet ALL of the following criteria: 1, 2, 3
- Minimal or no comorbidity
- Prior history of elevated PSA values
- Life expectancy >10–15 years
- Strong patient preference after shared decision-making
Evidence Supporting Age 70 Cutoff
- Men aged 75 years or older with PSA <3.0 ng/mL have only a 0.2% risk of dying from prostate cancer, making continued screening unnecessary. 2
- The median age of death from prostate cancer is 80 years, and 75% of men with localized disease die of other causes rather than prostate cancer. 2
- For men aged 60 with PSA <1 ng/mL, the risk of metastatic disease is only 0.5% and prostate cancer death is 0.2%, suggesting screening can safely stop in this low-risk group. 2
Risk-Stratified Approach for Men Aged 60–70
- PSA <1.0 ng/mL at age 60: Consider stopping screening entirely, given the extremely low risk of clinically significant disease. 2
- PSA 1.0–3.0 ng/mL: Continue screening every 2 years until age 70, then reassess based on health status. 2
- PSA ≥3.0 ng/mL: Continue annual screening and close surveillance, potentially extending beyond age 70 if the patient is very healthy. 2, 3
Colonoscopy Screening: When to Stop
Standard Stopping Age
- Discontinue routine colonoscopy screening at age 75 for average-risk individuals who have had adequate prior screening (defined as negative colonoscopy within 10 years or negative FIT/stool testing). [@Evidence not provided in studies—general medical knowledge applies@]
Selective Continuation Beyond Age 75
- Consider screening up to age 85 only in individuals who: [@Evidence not provided in studies—general medical knowledge applies@]
- Have never been screened or have inadequate prior screening
- Are in excellent health with life expectancy >10 years
- Have no significant comorbidities that would make colonoscopy high-risk
Key Principle: Life Expectancy Threshold
- Both PSA and colonoscopy screening require at least 10–15 years of remaining life expectancy to realize any mortality benefit, as the time lag between detection and potential death from these cancers is substantial. 1, 2, 4
Common Pitfalls to Avoid
- Continuing PSA screening beyond age 70 in men with limited life expectancy increases harms (false-positives, unnecessary biopsies, treatment complications) without providing benefit. 2, 4
- Failing to account for baseline PSA values when deciding to stop screening: Men with consistently low PSA (<1.0 ng/mL) in their 60s can safely stop earlier than age 70. 2
- Not having a shared decision-making conversation before stopping screening, especially in healthy men who may benefit from continued surveillance. 1, 4
- Ignoring comorbidities: Men with significant heart disease, diabetes, COPD, or other life-limiting conditions should stop screening earlier, as they are unlikely to live long enough to benefit. 2
Algorithm for Deciding When to Stop PSA Screening
Age 60–69:
- PSA <1.0 ng/mL → Consider stopping now 2
- PSA 1.0–2.5 ng/mL → Continue every 2 years until age 70 2
- PSA ≥2.5 ng/mL → Continue annually until age 70 2
Age 70:
- Life expectancy <10 years OR significant comorbidity → Stop screening 2, 4
- Excellent health + PSA ≥3.0 ng/mL + life expectancy >15 years → Consider continuing 2, 3
Age 75+:
- Stop screening in all men except those in exceptional health with prior elevated PSA and documented >15-year life expectancy 2