From the Guidelines
The frequency of PSA testing should be individualized based on age, risk factors, and previous PSA results, with testing typically beginning at age 50 for average-risk men and continuing every 1-2 years until around age 70, as recommended by the American Cancer Society guideline published in 2019 1. The decision to screen for prostate cancer using the PSA test should be made after a process of shared or informed decision making, taking into account the potential benefits and harms of screening, as well as the patient's general health and life expectancy 1.
- For men who choose to undergo PSA screening, the frequency of testing depends on their PSA level, with testing every 2 years generally sufficient for men with a PSA level less than 2.5 ng/mL, and annual testing recommended for men with PSA levels between 2.5-4 ng/mL 1.
- Men at higher risk, including African Americans and those with a family history of prostate cancer, should consider starting screening at age 40-45, as recommended by the American Cancer Society guideline 1.
- The American College of Physicians recommends that clinicians inform men between the age of 50 and 69 years about the limited potential benefits and substantial harms of screening for prostate cancer, and base the decision to screen 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 2.
- The frequency of screening should be determined based on the patient's individual risk factors and preferences, with the goal of minimizing harms while maximizing benefits, as recommended by the American College of Physicians guidance statement on screening for prostate cancer 2.
From the Research
Frequency of PSA Checks
The frequency of PSA checks is a crucial aspect of prostate cancer screening. According to the US Preventive Services Task Force (USPSTF) recommendation statement 3, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one and should include discussion of the potential benefits and harms of screening with their clinician.
- For men aged 55 to 69 years, the USPSTF recommends that the decision to undergo screening should be based on individual circumstances, taking into account factors such as family history, race/ethnicity, comorbid medical conditions, patient values, and other health needs.
- The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older, as the potential benefits of screening do not outweigh the expected harms.
Risk Factors and Screening Frequency
Certain risk factors, such as family history and inherited polygenic risk, can increase a man's risk of developing prostate cancer. A study published in Clinical Cancer Research 4 found that men with a family history of prostate or breast cancer and a high polygenic risk score had the highest rate of prostate cancer and prostate cancer-specific death.
- Men with a family history of prostate cancer or a high polygenic risk score may need to undergo more frequent PSA checks, as they are at higher risk of developing aggressive prostate cancer.
- However, the optimal screening frequency for these high-risk men is not well established and should be determined on an individual basis, taking into account their specific risk factors and medical history.
Impact of 5-Alpha Reductase Inhibitors on PSA Screening
5-alpha reductase inhibitors (5-ARIs) are medications that can reduce the risk of prostate cancer, but may also affect PSA levels and screening results. A study published in The Cochrane Database of Systematic Reviews 5 found that 5-ARIs reduced the risk of prostate cancer, but may increase the risk of high-grade disease in men who are undergoing regular screening for prostate cancer.
- Men taking 5-ARIs may need to undergo more frequent PSA checks, as these medications can affect PSA levels and screening results.
- However, the impact of 5-ARIs on PSA screening and prostate cancer risk is complex and requires further study to fully understand the benefits and harms of these medications in the context of prostate cancer screening.
Active Surveillance and PSA Screening
For men with low-risk prostate cancer, active surveillance may be a viable treatment option. A study published in the World Journal of Urology 6 found that 5-ARIs reduced the risk of reclassification and cross-over to treatment in men on active surveillance for prostate cancer.
- Men on active surveillance may need to undergo regular PSA checks to monitor their disease and adjust their treatment plan as needed.
- The frequency of PSA checks for men on active surveillance should be determined on an individual basis, taking into account their specific risk factors, medical history, and treatment plan.