How long to screen for Prostate-Specific Antigen (PSA)?

From the Guidelines

Men should be screened for PSA every 2 years if their PSA levels are less than 2.5 ng/mL, and yearly if their PSA levels are 2.5 ng/mL or higher, after a process of shared or informed decision making with their healthcare provider. The recommended frequency for PSA screening varies based on age and risk factors, with men at average risk starting discussions at age 50, and those at higher risk (African American men or men with a family history of prostate cancer) starting at age 45, or even 40 for those with multiple first-degree relatives diagnosed with prostate cancer at an early age 1. The screening process involves a simple blood test that measures PSA levels in the bloodstream, which can indicate potential prostate issues including cancer. However, PSA screening has limitations as elevated levels can result from non-cancerous conditions like prostatitis or benign prostatic hyperplasia. The decision to undergo PSA screening should be individualized through shared decision-making between patient and doctor, weighing the potential benefits of early cancer detection against the risks of false positives and unnecessary procedures. Factors that increase the risk of prostate cancer include African American race, a family history of prostate cancer, increasing age, an abnormal DRE, and age-specific PSA level, and methods like the Prostate Cancer Prevention Trial (PCPT) Prostate Cancer Risk Calculator can help estimate a man’s overall risk of prostate cancer and guide screening decisions 1.

Some key points to consider when making a decision about PSA screening include:

• The benefits and risks of screening, including the potential for early cancer detection and the risks of false positives and unnecessary procedures 1
• The individual's risk factors for prostate cancer, including age, family history, and ethnicity 1
• The potential for overdiagnosis and overtreatment of prostate cancer, particularly in men with low-risk disease 1
• The importance of shared decision-making between patient and doctor in making informed decisions about PSA screening 1

Overall, the decision to undergo PSA screening should be based on a careful consideration of the individual's risk factors, the potential benefits and risks of screening, and the importance of shared decision-making between patient and doctor. The most recent and highest quality study recommends screening intervals of every 2 years for men with PSA levels less than 2.5 ng/mL, and yearly for men with PSA levels 2.5 ng/mL or higher 1.

From the Research

Screening Interval for PSA

• The screening interval for Prostate-Specific Antigen (PSA) testing is generally recommended to be every 2 to 4 years in men 55 to 69 years of age at average risk 2.
• However, for high-risk men, such as African American men, consideration should be given to initiating screening at younger ages (e.g., 45-50 years) and at more frequent intervals relative to other racial groups in the United States 3.
• The evidence base for prostate cancer screening in African American men is limited by the lack of large, randomized studies, but available data suggest that screening at younger ages and more frequent intervals may be beneficial 3.

Factors Influencing Screening Interval

• Age: Older men may require less frequent screening, while younger men at high risk may require more frequent screening 2, 3.
• Race: African American men may require more frequent screening due to their higher risk of prostate cancer 4, 3.
• Family history: Men with a strong family history of prostate cancer may require more frequent screening 4.
• Baseline PSA measurement: Using a baseline PSA measurement in midlife can help optimize screening intervals 3.

Detection and Diagnosis

• Digital rectal examination (DRE) can be used in conjunction with PSA testing to detect prostate cancer, especially in men with suspicious DRE findings and PSA levels of 4 ng/mL or less 5.
• The positive predictive value of a suspicious DRE is appreciable in men with low serum PSA, and most cancers detected by DRE have features of clinically important and potentially curable disease 5.