Editing AUA: Prostate Cancer Screening (2018) (section)

== Statements ==

*'''<span style="color:#ff0000">Age to start screening</span>'''
**'''<span style="color:#ff0000">If age < 40, PSA screening is NOT recommended</span>'''
**'''<span style="color:#ff0000">If age > 40 and < 55,</span>'''
***'''<span style="color:#ff0000">Consider screening if risk factors present,</span> such as African American race or 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)'''
***'''<span style="color:#ff0000">Else, PSA screening is NOT recommended</span>'''
****However, neither is screening is explicitly actively discouraged in these men
**'''<span style="color:#ff0000">If age 55-69, PSA screening is recommended</span>''' (after shared decision-making)
***Recommendation is in line with the updated 2018 USPSTF grade C recommendation, which states that the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one for males aged 55 to 69 years
*'''<span style="color:#ff0000">Frequency of screening</span>'''
**'''<span style="color:#ff0000">Every 2 years or more</span>'''
***Modeling studies have projected that screening intervals of 2 years will preserve most of the benefits of screening and reduce the harms (i.e., false positive tests and overdiagnosis) when compared with screening every year.
***Intervals for rescreening can be individualized by a baseline PSA level.
*'''<span style="color:#ff0000">When to stop screening</span>'''
**'''<span style="color:#ff0000">If life expectancy < 10-15 years OR age > 70</span>'''
***There is a small subgroup of men over age 70 years who are in excellent health may benefit from PSA screening
****In order to identify the older man more likely to benefit from treatment if screening takes place, the Panel recommends two approaches:
*****Increasing the prostate biopsy threshold based on evidence that men with a PSA level above 10ng/mL are more likely to benefit from treatment of prostate cancer when compared to those with a PSA below 10ng/mL
***** Discontinuation of PSA screening among men with a PSA < 3ng/mL, given evidence that these men have a significantly lower likelihood of being diagnosed with a lethal prostate cancer during the remaining years of life when compared to men with a PSA above 3ng/mL