Prostate Cancer Screening Guidelines

Study Notes

The USPSTF (2018) recommends individual discussions about prostate cancer screening for men aged 55-69.
For men over 70 or with a life expectancy of less than 10 years, screening is generally not recommended.
The USPSTF recommends against routine screening for most men.
Screening with PSA and DRE should start at age 50 for most men.
Consider screening at age 45 for high-risk individuals (first-degree relative with prostate cancer before age 65, or Black ethnicity).
For men with more than one first-degree relative with prostate cancer history, begin screening at age 40.
PSA levels above 4 ng/mL may require further investigation (e.g., biopsy or imaging).
Screening frequency depends on risk factors like age, family history, and ethnicity.

Digital Rectal Exam (DRE): Palpable abnormalities suggest malignancy.
Elevated Prostate-Specific Antigen (PSA): Testing levels require follow-up.
PSA typically below 4 ng/mL, however a normal PSA does not rule out cancer. A >10ng/mL PSA generally necessitates biopsy, but only about 20% of patients with a PSA of 4-9.9ng/mL have prostate cancer.
Prostate cancer antigen 3 (PCA3), TMPRSS2-ERG gene fusion, and prostate health index (PHI) are additional tests used with PSA for a more comprehensive diagnostic evaluation.
Testosterone, liver function tests, if suspecting androgen deprivation.
Transrectal biopsy with transrectal ultrasound (TRUS) guidance for prostate biopsy.
CT scans, primarily to evaluate prostate size and assess pelvic lymph node involvement.
MRI and bone scan if PSA >20ng/mL or Gleason Score >8.
Gleason score > 8 indicates a higher likelihood of cancer spreading rapidly.
Bone scan is indicated if PSA > 20 (always if metastasis is suspected).

Referral to a urologist is recommended if PSA levels are high or DRE findings are suspicious.
Follow-up involves monitoring PSA levels and periodic reevaluation.
Clinical exams with PSA every 6 months for 5 years, then annually.
DRE annually.
If under active surveillance, repeat prostate biopsies are recommended 1 year after an initial diagnosis and every 2-4 years.
Men treated with anti-androgen deprivation therapy require additional evaluation.