Prostate Cancer: Screening Guidelines

Prostate cancer is the most common cancer found in American men, other than skin cancer. Prostate cancer is the second leading cause of cancer death in men, behind only lung cancer. Each year, more than 200,000 men are diagnosed with prostate cancer and an estimated 30,000 will die of the disease. About one in six men in the United States will be diagnosed with prostate cancer in their lifetime, and about one in 35 will die of it.

Many prostate cancers will not cause symptoms, spread, or shorten a man’s life even if left untreated. These slow-growing cancers are known as indolent cancers. Treating an indolent cancer does not have any benefit, and may actually cause harm. Learn more about monitoring prostate cancer using an approach called active surveillance.

Prostate Cancer Risk

The following factors may increase your risk of developing prostate cancer:

Age

The biggest risk factor for developing prostate cancer is age. The disease usually occurs in men older than age 50. More than 60 percent of prostate cancers are found in men who are 65 or older.

Race

Men of African American descent are at higher risk of developing prostate cancer at a young age than are Caucasian men. They are also more likely to have disease that has spread outside the prostate gland at the time of diagnosis and are more likely to die of prostate cancer.

Family History

Men who have close relatives such as a father or brother who have had prostate cancer ­– especially if they were younger than 60 when they were diagnosed – have a slightly higher risk for developing the disease. Studies suggest that 5 to 10 percent of all cases of prostate cancer may be related to inherited genetic factors.

Prostate Cancer Screening

Not all prostate cancers are alike. More than 90 percent are found when they are confined to the prostate gland, and while some spread early and require treatment, many others are slow-growing and are unlikely to cause serious problems during a man’s lifetime.

The prostate-specific antigen test (PSA) measures the level of a protein produced by the prostate that circulates in a man’s blood. When there is a problem with the prostate, PSA levels are higher. For example, men who have a common condition called benign prostatic hyperplasia (BPH) may have elevated PSA levels; however, BPH is not cancer.

While an elevated PSA level (3.0 ng/mL or higher) indicates that further testing should be considered, most men with a high PSA do not have prostate cancer. For a diagnosis of prostate cancer, a biopsy of the prostate is required.

There is now good evidence from randomized controlled trials that PSA screening can reduce the risk of death from prostate cancer in men. However, there are many men who do not benefit from treatment for prostate cancer and may suffer from the side effects of treatment. This is because prostate cancer is often so slow growing that it would not cause a man any problems during the course of his natural life. PSA screening therefore needs to be a careful balance of benefits – reduced cancer deaths – versus the harm that may result from unnecessary treatment of men whose cancers would not threaten their health or survival.

Our Prostate Cancer Screening Guidelines

Memorial Sloan Kettering’s prostate cancer guidelines are based on the following principles:

  1. Many men with prostate cancer do not need to be treated and can be followed by active surveillance. A diagnosis of prostate cancer is information used to help make decisions, not an indication for immediate treatment.
  2. Compliance with screening will increase if men are told whether they are at high, intermediate, or low risk and are informed about their need for subsequent screening.
  3. There is a balance between the harms and benefits of screening. By focusing screening on men at highest risk of life-threatening prostate cancer, we can better achieve this balance.

Our doctors recommend the following screening guidelines for men expected to live at least 10 years:

  • Men aged 45 – 49 should have a baseline PSA test.
    • If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate
    • If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every 2 - 4 years
    • If the PSA level is less than 1  ng / mL, men should see their doctor for another PSA test at age 51 – 55
  • Men aged 50 – 59 should have their PSA level checked.
    • If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate
    • If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every 2 - 4 years
    • If the PSA level is less than 1 ng / mL, men should see their doctor for another PSA test at age 60
  • Men aged 60 – 70 should have their PSA checked.
    • If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate
    • If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every 2 - 4 years
    • If the PSA level is less than 1 ng / mL, no further screening is recommended
  • Men aged 71 – 75 should talk with their doctor about whether to have a PSA test. The decision whether to have a PSA test should be based on past PSA levels and health of the man.

  • Prostate cancer screening is not recommended for men aged 76 or older.

A high PSA level does not generally mean that a man should have a prostate biopsy. A doctor will often repeat the PSA test after a few months to determine if it is still high and investigate whether there is a reason other than cancer that could explain why the PSA level is elevated.

Prostate Cancer Screening Guidelines: Summary

There is clear evidence that screening with a PSA test can reduce the number of deaths from prostate cancer. Many men with cancers detected by the PSA test are treated even though their cancer is not aggressive and would not become apparent during the course of their natural life if it was detected by screening. Such treatment can lead to long-term problems with urinary and sexual function. The Memorial Sloan Kettering Cancer Center Prostate Cancer Disease Management Team recommends that men interested in the early detection of prostate cancer be informed of their risk and be advised to consider screening according to the guidelines above.

These guidelines were developed by James Eastham, Chief of the Urology Service at Memorial Sloan Kettering Cancer Center; Andrew Vickers, a statistician in the Department of Epidemiology and Biostatistics; Hans Lilja, from the Departments of Laboratory Medicine and Surgery, and an investigator on the European Randomized Study of Prostate Cancer screening (ERSPC); and Peter Scardino, Chair of the Department of Surgery.