As I have discussed before, PSA screening in the United States has become a divisive issue. Currently, the evidence to support PSA screening conflicts evidence that shows this test may be finding non-lethal cancers and leading to excessive prostate needle biopsies.
Previously, PSA screening was recommended to begin at age 45 in men at high risk (African American; relatives with prostate cancer) and age 50 for everyone else.
In light of the conflicting data, the American Urological Association recently released new guidelines to advise patients as to how approach this evidence.
- Men under age 40 should not have PSA testing in routine circumstances.
- Men aged 40 to 54 without the above high risk factors should not undergo PSA testing unless indicated by concerns for their prostatic health. Men with such concerns should discuss their options with their urologist.
- Men aged 55-69 should consider the benefit to PSA screening after a discussion with their phsician. Reasons for this include the prevention of 1 prostate cancer death for 1000 screened individuals over 10 years.
- For screening, rather than every year, a screening interval of two years may be preferred to preserve the majoring of benefits and reduce overdiagnosis and false positives.
- PSA screening should not be done in men over 70 years of age or in men with less than 10 to 15 years of life expectancy.
As this information continues to evlove I will do my best to update. In the future I expect new testing to be created to increase the specificity of prostate cancer detection.