Prostate Cancer: Screening Guidelines

There is now good evidence that PSA screening can reduce the risk of death from prostate cancer in men. However, many men 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.

That’s why our experts created PSA screening guidelines that reflect 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 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.

The following screening guidelines apply to men expected to live at least 10 years.

Men aged 45 – 49

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

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

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

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.

Men 76 and older

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 MSK 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; 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.