From the Guidelines
Men with a family history of prostate cancer should begin screening at age 45, or 10 years before the age at which their youngest affected relative was diagnosed, whichever comes first. This recommendation is based on the most recent and highest quality study available, which suggests that earlier screening can lead to better outcomes for men with a family history of prostate cancer 1. Screening involves a prostate-specific antigen (PSA) blood test and possibly a digital rectal examination (DRE). The frequency of screening depends on initial PSA results: if PSA is less than 1 ng/mL, testing every 2-4 years is reasonable; if PSA is 1-3 ng/mL, annual testing is recommended.
Key Considerations
- Men with multiple first-degree relatives (father, brother) diagnosed with prostate cancer before age 65 have the highest risk and should consider more aggressive screening approaches.
- African American men with family history face even higher risk and may benefit from starting screening at age 40-45.
- The rationale for earlier screening is that prostate cancer has a genetic component, with a 2-3 times higher risk in men with affected first-degree relatives.
- Earlier detection allows for more treatment options and potentially better outcomes.
- However, screening decisions should always involve a discussion with your doctor about the benefits and potential harms of testing, including the possibility of false positives and unnecessary procedures.
Screening Guidelines
- The American Cancer Society recommends that men with a family history of prostate cancer begin screening at age 45 1.
- The National Comprehensive Cancer Network (NCCN) also recommends that men with a family history of prostate cancer begin screening at age 45, or 10 years before the age at which their youngest affected relative was diagnosed, whichever comes first 1.
From the Research
Prostate Cancer Screening with a Family History
- Men with a family history of prostate cancer are considered to be at higher risk for developing the disease 2
- However, the study by 3 found that the risk associated with a positive family history was not substantially increased, and that selective screening among men with affected relatives may not be effective
- The American Family Physician recommends shared decision-making before initiating screening, and most guidelines recommend screening every 2 to 4 years in men 55 to 69 years of age at average risk 2
- For men with a family history of prostate cancer, it is recommended to start screening at an earlier age, but the exact age is not specified in the studies provided
- The use of prostate-specific antigen (PSA) testing, digital rectal examination (DRE), and transrectal ultrasonography (TRUS) are common methods for detecting prostate cancer, but the effectiveness of these methods in men with a family history is not clearly established 4, 5, 6
- The combination of PSA and DRE may improve the stage of diagnosis of patients with prostate cancer, but larger, randomized studies are needed to evaluate the effect of screening on overall survival 5, 6