From the Guidelines
Men between the ages of 50 and 69 should discuss the limited potential benefits and substantial harms of screening for prostate cancer with their healthcare provider, and the decision to screen should be based on the risk for prostate cancer, a discussion of the benefits and harms of screening, the patient's general health and life expectancy, and patient preferences. The guidelines for testing PSA and how often to test are complex and depend on various factors, including age, risk factors, and patient preferences 1.
Key Considerations
- The USPSTF recommends against screening for prostate cancer using the PSA test, citing that the harms of screening outweigh the benefits for most men 1.
- The American College of Physicians (ACP) recommends that clinicians inform men between the ages of 50 and 69 about the limited potential benefits and substantial harms of screening for prostate cancer, and that the decision to screen should be based on individual risk factors, values, and preferences 1.
- The frequency of screening should be individualized, but there is no clear evidence to support annual screening, and longer intervals between screening tests may reduce harms 1.
- Men with higher PSA levels may need more frequent testing or additional evaluation, and biopsy should be considered in those aged 45 to 75 years with a serum PSA greater than 3.0 ng/mL 1.
Special Considerations
- Men at high risk, including African Americans and those with a family history of prostate cancer, should be informed about the potential benefits and risks of testing, and screening should be considered starting at age 40-45 1.
- Men over 70 years old or those with a life expectancy less than 10 years should not be screened for prostate cancer, as the harms of screening outweigh the benefits 1.
- Shared decision-making between clinicians and patients is essential in making choices about prostate cancer screening, and patients should be informed about the potential benefits, limitations, and harms associated with testing 1.
From the Research
Guidelines for Testing PSA
- The American Cancer Society recommends that men should discuss the pros and cons of PSA testing with their doctor before deciding whether to be tested 2.
- The decision to test should be based on a man's individual risk factors, such as age, family history, and ethnicity.
- For men at average risk of prostate cancer, the PSA test can be done annually, but the frequency of testing should be determined by the doctor based on the individual's risk factors.
How Often to Test PSA
- The study published in 1994 found that a single PSA test can detect prostate cancer in men over 50 years of age, but the sensitivity and specificity of the test are not perfect 3.
- The study published in 2017 suggests that men should decide for themselves whether to be tested, based on their own values and risk factors 2.
- There is no consensus on the optimal frequency of PSA testing, but most guidelines recommend annual testing for men at high risk of prostate cancer.
Factors Affecting PSA Levels
- Digital rectal examination, prostatic massage, and ultrasonography have minimal effects on serum PSA levels in most patients 4.
- Prostatic needle biopsy can cause marked elevations of serum PSA levels, which can last longer than expected in some patients 4.
- PSA levels can be affected by various factors, including age, race, and prostate size, but these factors do not significantly influence the duration of PSA elevation after biopsy 4.
Detection of Prostate Cancer
- The study published in 1999 found that digital rectal examination can detect prostate cancer in men with PSA levels of 4 ng/ml or less, particularly in older men and those with higher PSA levels 5.
- The study published in 2025 found that combined fusion biopsy (ComBx) offers superior detection rates for prostate cancer compared to transrectal ultrasound-guided biopsy (TRUS-Bx), particularly for clinically significant prostate cancer 6.