Editing Prostate Cancer: Screening (section)

== Frequency of Screening/Discontinuing Screening ==

=== CUA ===

* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9054332/ '''2022 CUA Guidelines on Prostate Cancer Screening''']
** '''<span style="color:#ff0000">Frequency</span>'''
*** '''<span style="color:#ff0000">PSA < 1 ng/mL: every 4 years</span>'''
*** '''<span style="color:#ff0000">PSA 1-3 ng/mL: every 2 years</span>'''
*** '''<span style="color:#ff0000">PSA >3 ng/mL: consider more frequent PSA testing intervals or adjunctive testing strategies</span>'''
**'''<span style="color:#ff0000">Discontinuing</span>'''
***'''<span style="color:#ff0000">If age >60 and PSA <1 ng/ml'''
***'''<span style="color:#ff0000">If age >70'''
***'''<span style="color:#ff0000">If life expectancy < 10 years'''

=== AUA ===
*'''[[AUA: Early Detection of Prostate Cancer (2023)|2023 AUA Guideline Notes on PSA Screening]]'''
**'''<span style="color:#ff0000">Offer regular prostate cancer screening every 2 to 4 years to people aged 50 to 69 years.</span>'''
**'''<span style="color:#ff0000">May personalize the re-screening interval, or decide to discontinue screening, following SDM, based on</span>'''
***'''<span style="color:#ff0000">Prostate cancer risk</span>'''
****'''<span style="color:#ff0000">If at increased risk of developing prostate cancer, based on Black ancestry, germline mutations, or strong family history, consider screening more frequently</span>'''
***'''<span style="color:#ff0000">PSA</span>'''
**** '''<span style="color:#ff0000">If age 45-70 and</span>'''
*****'''<span style="color:#ff0000">PSA 1-3 ng/mL, re-screening interval can be 1-4 years</span>'''
***** '''<span style="color:#ff0000">PSA < 1 ng/mL, re-screening interval can be prolonged</span>'''
****'''If age 60 and PSA < 1 ng/mL (age-specific median), reasonable to significantly lengthen the re-screening interval or discontinue screening, based on SDM, provided there are no other risk factors, such as strong family history of prostate cancer'''
****The Panel notes most studies regarding baseline PSA have been conducted in populations of primarily White patients.
*****The Southern Community Cohort Study (100% Black patients) showed that PSA levels in midlife were similar to those among White controls in prior studies and were strongly associated with risk of aggressive prostate cancer.
***'''<span style="color:#ff0000">Age</span>'''
****'''<span style="color:#ff0000">If age age ≥75  and PSA is < 3 ng/mL, may discontinue or substantially lengthen the re-screening interval for patients.</span>'''
***'''<span style="color:#ff0000">Life expectancy</span>'''
****'''<span style="color:#ff0000">In select patients who are very healthy with an estimated life expectancy of at ≥10 years, ongoing screening every 2-4 years is reasonable</span>'''
****'''<span style="color:#ff0000">For patients with < 10 year estimated life expectancy, screening is not likely to provide a benefit in terms of disease-specific or overall mortality.</span>'''
*****Based on current Social Security Administration (SSA) data, American men older than 77 years of age have less than a 10-year life expectancy.
**** '''<span style="color:#ff0000">Risk calculators have been developed to estimate a patient’s life expectancy</span>'''
***** For the purpose of estimating life expectancy, the use of these tools is likely more reliable than individual clinician judgment.
***** Life expectancy risk calculators
******[https://www.ssa.gov/oact/population/longevity.html US Social Security Administration]
******[https://webcore.mskcc.org/survey/surveyform.aspx?preview=true&excelsurveylistid=4 Memorial Sloan Ketettering Cancer Center Male Life Expectancy Survey]
******[http://cambridgeprognosticgroup.com/notloggedin.php Cambridge Prognostic Groups]
***'''General health''' 
***'''Patient preference'''
*Historical
**'''[[AUA: Prostate Cancer Screening (2018)|2018 AUA Guideline Notes on PSA Screening]]'''
*** Frequency
****Every 2 years or more
***** Intervals for rescreening can be individualized by a baseline PSA level
***Discontinuing
****If life expectancy <10-15 years OR age > 70
***** Select males age > 70 who are in excellent health may benefit from PSA screening

=== NCCN ===
*'''<span style="color:#ff0000">2024 NCCN Guidelines</span>[https://www.nccn.org/guidelines/category_2]'''
** '''<span style="color:#ff0000">Frequency</span>'''
***'''<span style="color:#ff0000">If average risk</span>'''
**** '''<span style="color:#ff0000">PSA <1 ng/mL, repeat testing every 2 to 4 years</span>'''
**** '''<span style="color:#ff0000">PSA 1-3 ng/mL, repeat testing every 1 to 2 years</span>'''
***** '''Use clinical judgement'''
****** Younger individual on the higher end of PSA (eg, a 45-year-old with PSA 0.9 ng/mL) might be screened in 2 years, whereas an older individual with a lower PSA might be screened in 4 years
*** '''<span style="color:#ff0000">If high risk</span>'''
**** '''<span style="color:#ff0000">PSA ≤ 3 ng/mL, repeat testing every 1 to 2 years</span>'''
***'''If age >75 and undergoing screening'''
**** '''If PSA < 4 ng/mL, normal DRE, and no other indications for biopsy: repeat testing every 1-2 years, but only in very healthy individuals'''
**** '''If PSA >4 ng/ml OR very abnormal DRE, consider biopsy (+/- pre-biopsy MRI)'''
**'''<span style="color:#ff0000">Discontinuing</span>'''
***'''<span style="color:#ff0000">If life expectancy < 10 years OR age > 75</span>'''
**** '''Continuing screening beyond age 75 years should be performed only with caution in very healthy patients with little to no comorbidity'''