From the Guidelines
The current recommended approach for prostate cancer screening involves shared decision-making between men and their healthcare providers, with PSA (prostate-specific antigen) blood testing as the primary screening method, as stated in the most recent guidelines 1.
Key Recommendations
- For men at average risk, discussions about screening should begin at age 50, while those at higher risk (African American men or those with a family history) should start discussions at age 45 or even 40 for men with multiple affected relatives 1.
- If screening is chosen, the typical interval is every 1-2 years for men with PSA levels below 2.5 ng/mL, and annually for those with higher levels 1.
- Digital rectal examination (DRE) may be performed alongside PSA testing but is not recommended as a standalone screening tool 1.
Rationale
The rationale for these recommendations balances the potential benefits of early detection against the risks of overdiagnosis and overtreatment, as many prostate cancers are slow-growing and may never cause symptoms or require treatment during a man's lifetime 1.
Considerations
- Screening is generally not recommended for men with less than 10-15 years of life expectancy or those over 70 years old 1.
- PSA testing can help identify cancer early when treatment is most effective, but can also lead to unnecessary biopsies and treatments with significant side effects 1.
Decision-Making
- Prostate cancer screening should not occur without an informed decision-making process, and men should either receive information directly from their healthcare providers or be referred to reliable and culturally appropriate sources 1.
- Patient decision aids are helpful in preparing men to make a decision whether to be tested 1.
From the Research
Current Recommended Methods for Screening Prostate Cancer
- The use of high-quality magnetic resonance imaging (MRI) is recommended for active surveillance of prostate cancer, allowing digital rectal examination (DRE) to be omitted in some cases 2.
- Repeat standard biopsy can be omitted when MRI and prostate-specific antigen (PSA) kinetics are stable 2.
- Changes in PSA or DRE should prompt MRI ± biopsy rather than immediate active treatment 2.
Intervals for Screening Prostate Cancer
- Baseline MRI is effective for identifying clinically significant prostate cancer and thus associated with fewer reclassification events 3.
- Surveillance MRI, obtained after initial biopsy, yielded a positive predictive value (PPV) of 11-65% and negative predictive value (NPV) of 85-95% for reclassification 3.
- The optimal timing of digital rectal examination (DRE), general health assessment, or re-biopsy strategies is not universally agreed upon 4.
Research Priorities
- The development of a dynamic, risk-adjusted approach to surveillance is the highest research priority in active surveillance for prostate cancer 2.
- Improving the tests used in surveillance, ensuring equity of access and experience across different patients and settings, and improving information and communication between and within clinicians and patients are also high priorities 2.
- Further research is necessary to fully integrate MRI into active surveillance and to assess the long-term outcomes of using active surveillance in intermediate-risk groups 3, 5.