Prostate-Cancer Screening Guidelines

The rationale for screening is that early detection and treatment of asymptomatic cancers could extend life, as compared with treatment at the time of clinical diagnosis. The introduction of prostate-specific antigen (PSA) testing has nearly doubled the lifetime risk of receiving a diagnosis of prostate cancer.

Prostate-Cancer Screening Guidelines.

Recommendation	American Urological Association	American Cancer Society
Shared decision making between patient and clinician	Yes	Yes (consider use of decision aid)
Age to begin offering screening? (yr) *Average-risk patients *High-risk patients (black patients and those with first-degree relative with prostate cancer)	40 40	50 40-45
Discontinuation of screening	Life expectancy <10 yr	Life expectancy <10 yr
Screening tests	PSA, digital rectal examination	PSA, optional digital rectal examination
Frequency of screening	Annual (possibly less often for men in their 40s)†	Annual (every other year when PSA <2.5 ng/ml)
Criteria for biopsy referral	Age, family history, race or ethnic group, findings on digital rectal examination, total PSA, free PSA, PSA velocity, PSA density, previous biopsy findings, coexisting conditions	PSA >/=4.0 ng/ml, abnormal digital rectal examination; individualized risk assessment if PSA is 2.5–4.0 ng/ml

† The guidelines indicate that the initial PSA value at 40 years of age (relative to the median value of 0.6 to 0.7 ng per milliliter for this age group) would determine subsequent (but unspecified) screening intervals. The National Comprehensive Cancer Network recommends using a PSA cutoff level to determine whether subsequent testing should be performed annually or at 45 years of age (and then at 50 years of age). However, these recommendations are not evidence-based.


References:

1. Hoffman RM. Screening for Prostate Cancer. N Engl J Med. 2011 Oct 26. [Medline]
2. Wolf AM, Wender RC, Etzioni RB, Thompson IM, D'Amico AV, Volk RJ, Brooks DD, Dash C, Guessous I, Andrews K, DeSantis C, Smith RA; American Cancer Society Prostate Cancer Advisory Committee. American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J Clin 2010;60:70-98. [Medline]
3. Greene KL, Albertsen PC, Babaian RJ, Carter HB, Gann PH, Han M, Kuban DA, Sartor AO, Stanford JL, Zietman A, Carroll P. Prostate specific antigen best practice statement: 2009 update. J Urol 2009;182:2232-41. [Medline]