Editing Prostate Cancer: Screening (section)

== When to Start Screening ==

=== CUA ===

* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9054332/ '''2022 CUA Guidelines on Prostate Cancer Screening''']
** '''If age < 45, PSA screening is NOT recommended'''
** '''<span style="color:#ff0000">If age >45 and < 50'''
*** '''<span style="color:#ff0000">Offer screening in males at increased risk of prostate cancer (e.g. family history of prostate cancer in a first- or second-degree relative)'''
** '''<span style="color:#ff0000">If age >50, starting screening is suggested'''

=== AUA ===
*'''[[AUA: Early Detection of Prostate Cancer (2023)|2023 AUA Guideline Notes on PSA Screening]]'''
**'''If age < 40, PSA screening is NOT recommended'''
**'''<span style="color:#ff0000">If age > 40 and < 45</span>'''
***'''<span style="color:#ff0000">Offer screening if at increased risk of developing prostate cancer based on (3):</span>'''
***#'''<span style="color:#ff0000">Black ancestry</span>''' 
***# '''<span style="color:#ff0000">Germline mutations (BRCA, Lynch Syndrome)</span>'''
***#'''<span style="color:#ff0000">"Strong" family history of prostate cancer</span>'''
***##'''<span style="color:#ff0000">Criteria for "strong" family history (2):[https://pubmed.ncbi.nlm.nih.gov/37096582/]</span>'''
***###'''<span style="color:#ff0000">≥1 brother or father OR ≥2 male relatives with one of the following (3):</span>'''
***####'''<span style="color:#ff0000">Diagnosed with prostate cancer at age <60 years</span>'''
***####'''<span style="color:#ff0000">Any of whom died of prostate cancer</span>''' 
***####'''<span style="color:#ff0000">Any of whom had metastatic prostate cancer.</span>'''
***###'''<span style="color:#ff0000">Family history of other cancers with ≥2 cancers in hereditary breast and ovarian cancer syndrome or Lynch syndrome spectrum.</span>'''
***###*'''See associated cancers in [[Prostate Cancer: Epidemiology and Pathogenesis]] Chapter Notes'''
***## '''<span style="color:#ff0000">Patients with a "strong" family history should ideally be genotyped</span>[https://pubmed.ncbi.nlm.nih.gov/37096582/]'''
**'''<span style="color:#ff0000">If age >45-50, may begin prostate cancer screening and offer a baseline PSA test</span>'''
***Change from 2018 guidelines which recommended screening if age 55-69
****The 2023 guidelines describe that earlier initiation of screening is supported by observational studies that have demonstrated a prognostic value of obtaining a baseline PSA in early midlife
****The randomized trials that demonstrate a benefit for prostate cancer screening (Goteborg-1 and ERSPC) began at ages 50 and 55 years, respectively.
***No randomized evidence showing a benefit to initiation of routine screening for prostate cancer before 45 years of age.
*Historical
**'''[[AUA: Prostate Cancer Screening (2018)|2018 AUA Guideline Notes on PSA Screening]]'''
*** If age < 40, PSA screening is NOT recommended
*** If age ≥ 40 and < 55
**** Consider screening if risk factors present, including:
***** African American race
***** Family history of metastatic or lethal adenocarcinomas (e.g., prostate, male and female breast cancer, ovarian, pancreatic) spanning multiple generations, affecting multiple first-degree relatives, and that developed at younger ages (age < 55)
**** Else, PSA screening is NOT recommended
**** However, neither is screening is explicitly actively discouraged in these men
*** If age ≥ 55 and ≤  69, PSA screening is recommended (after shared-decision making)

=== NCCN ===
*'''<span style="color:#ff0000">2024 NCCN Guidelines</span>[https://www.nccn.org/guidelines/category_2]'''
** '''<span style="color:#ff0000">If age < 40, PSA screening is NOT recommended</span>'''
** '''<span style="color:#ff0000">If age ≥ 40 and < 45</span>'''
*** '''<span style="color:#ff0000">Consider screening if risk factors (same as AUA, see above) present</span>'''
*** '''<span style="color:#ff0000">Else, PSA screening is NOT recommended</span>'''
** '''<span style="color:#ff0000">If age ≥ 45 and ≤ 75, PSA screening is recommended (after shared-decision making)</span>'''