Prostate Cancer Screening Guidelines

Prostate Screening Guidelines

• 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.

Risk Factors

• Age: Risk increases after age 50.
• Family history of prostate cancer.
• African American ethnicity.
• Diet high in red meat and low in fruits and vegetables.

Diagnostics

• 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 and Follow-up

• 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.