Editing CUA: Prostate Cancer Screening (2017) (section)

== Best screening practices ==

* '''For men electing to undergo PSA screening, we suggest starting PSA testing at age 50 in most men and at age 45 in men at an increased risk of prostate cancer'''
** Remains unclear which men will benefit from early PSA screening, family history imparts a substantially increased risk of prostate cancer diagnosis at a '''younger age.'''
** '''These recommendations are not directed towards men with known germ-line mutations associated with PC''' (e.g. BRCA1, BRCA2, HOXB13). In these cases, an individualized testing strategy after consultation with a clinical genetist is most appropriate.
* '''For men electing to undergo PSA screening, intervals between testing should be based on previous PSA levels:'''
** '''For men with PSA < 1 ng/mL, repeat PSA testing every 4 years'''
** '''For men with PSA 1 – 3 ng/mL, repeat PSA testing every 2 years'''
** '''For men with PSA > 3 ng/mL, consider more frequent PSA testing intervals or adjunctive testing strategies'''
** Although the added utility of DRE in addition to PSA is controversial, DRE may increase the detection of clinically significant disease; '''DRE should performed at the same interval as PSA testing'''
* '''For men electing to undergo PSA screening, consider discontinuing PSA screening for men:'''
*# '''Aged 60 with a PSA < 1 ng/mL, consider discontinuing PSA screening'''
*# '''At age 70'''
*#* Men aged > 70 have the highest incidence of PC over-diagnosis and several studies have suggested that screening in this age group is likely not beneficial; a modelling study using data from ERSPC found that any potential benefit to screening in men over 70 was offset by the detriments to quality of life
*#* '''For interested men in excellent health at age 70, PSA testing can be considered recognizing the lack of empirical data in this age group. As such, for these men, continued PSA testing is a matter of clinical judgement and personal preferences.'''
*# '''With a life expectancy < 10 years'''