Prostate Cancer Screening Guidelines

There is clear evidence that screening with a prostate-specific antigen (PSA) test can reduce the number of deaths from prostate cancer. However, prostate cancer is often so slow growing that it would not cause a man any problems during the course of his life. For that reason, many men do not benefit from treatment for prostate cancer and may unnecessarily suffer from its side effects, such as long-term problems with urinary and sexual function.

The Memorial Sloan Kettering 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 below.

Our experts created these screening guidelines to reflect a careful balance of the benefits — reduced cancer deaths — versus the harm that may result from unnecessary treatment of men whose cancers would not threaten their health or survival.

The guidelines are based on the following principles:

  • Many men with prostate cancer can be followed by active surveillance. A diagnosis of prostate cancer is information used to help make decisions, not an indication for immediate treatment.
  • 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.
  • There is a balance between the harms and benefits of screening. By focusing screening on men at the highest risk for life-threatening prostate cancer, we can better achieve this balance.

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

Men ages 45 to 49

Men ages 45 to 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 two to four years.
  • If the PSA level is less than 1 ng / mL, men should see their doctor for another PSA test between the ages of 51 and 55.

Men ages 50 to 59

Men ages 50 to 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 two to four years.
  • If the PSA level is less than 1 ng / mL, men should see their doctor for another PSA test at age 60.

Men ages 60 to 70

Men ages 60 to 70 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 two to four years.
  • If the PSA level is less than 1 ng / mL, no further screening is recommended.

Men ages 71 to 75

Men ages 71 to 75 should talk with their doctor about whether to have a PSA test. This decision should be based on past PSA levels and the health of the man.

Men ages 76 and older

Prostate cancer screening is not recommended for men ages 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 the PSA level is still high and investigate whether there is a reason other than cancer that could explain the increase.

These screening 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.