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PSA Screening, and Its Role in Active Surveillance
With Drs. James Eastham, Michael Morris, and Michael Zelefsky, moderated by WCBS-TV's Max Gomez

Physicians routinely use two examinations to screen men for prostate cancer.

During the first type of examination, which is called a digital rectal examination (DRE), a doctor inserts a gloved finger into the rectum to feel for lumps in the prostate.

The second, a blood test, detects the amount of prostate-specific antigen (PSA) circulating in the blood. PSA is a protein produced by the prostate; it is a good indicator of activity (such as cell division) in the gland. A prostate that feels abnormal and an elevated PSA level (greater than or equal to 4.0 ng/ml) are both possible indicators of the disease; however neither test alone or in combination can provide a definitive diagnosis of prostate cancer. (Men who have a common, noncancerous condition called benign prostatic hyperplasia (BPH) may also have elevated PSA levels.)

If either test is abnormal, your physician may suggest you have a biopsy, which can provide much more information and is required before a diagnosis can be made.

Computer-Assisted Family History Analysis

Memorial Sloan-Kettering is one of the few centers that offers computer-assisted family history analysis. Men with a family history of prostate cancer that suggests an increased genetic risk may be referred to our genetic counselors, who can help further evaluate their risks. Family members, too, may be offered genetic counseling.

Our Prostate Cancer Screening Guidelines

Our doctors recommend the following screening guidelines:

For men in the general population, prostate cancer screening -- using both PSA testing and a DRE -- should begin at age 50. In high-risk groups such as African-American men and men with a family history of prostate cancer, prostate cancer screening -- using both PSA testing and DRE -- should begin at age 40.

If a man screened with DRE receives an abnormal result, regardless of PSA level, he should be referred to a urologist for further testing.

To balance the influence of age on PSA levels, the following age-specific PSA level cut-offs should be considered:

  • Greater than or equal to 2.5 ng/mL for men up to age 49
  • Greater than or equal to 3.5 ng/mL for men aged 50 to 59
  • Greater than or equal to 4.0 ng/mL for men aged 60 and older.

Men with values outside their age-allowed targets should be considered as candidates for prostate biopsy.

For those men being screened for PSA velocity, a PSA velocity of greater than or equal to 0.75 ng/mL per year should necessitate a prostate biopsy -- even if the PSA level is in the normal range.

Again, it is important to remember that the evidence supporting the usefulness of prostate cancer screening is suggestive but not definitive, and to note the potential harms (i.e. anxiety, biopsy complications) that may result from prostate cancer screening. As always, the subject of prostate cancer screening should be discussed with your physician.

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Last Updated: Nov. 17, 2008
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