Screening for prostate cancer

This section covers these topics:

• Benefits and harms of prostate cancer screening
• Types of screening
• Screening recommendations for high-risk men
• Screening recommendations for average-risk men

Benefits and harms of screening

There are benefits and potential harms associated with prostate cancer screening.

• Most prostate cancers can be very slow growing and unlikely to spread or cause harm. Detecting and treating these slow-growing prostate cancers early may not improve health outcomes and side effects from biopsy or treatment may cause harm.
• Some prostate cancers can be very aggressive, spreading to other organs and increasing the risk of death. Finding these cancers early through screening may help men live longer. These aggressive cancers are more common in:
  • African American men.
  • Men with inherited mutations in certain genes, including BRCA1, BRCA2 and ATM.
  • Men with a family history of young-onset or aggressive prostate cancer.

The benefits and risks of prostate cancer screening differ based on several personal factors:

• age
• overall health 
• lifetime risk for prostate cancer
• risk for developing aggressive disease
• personal preferences

Several expert groups have guidelines for prostate cancer screening and each is slightly different. Most experts agree that men should have a discussion with their doctor about prostate cancer screening, that includes:

• their risk for developing prostate cancer
• their risk for developing aggressive disease
• the benefits and harms of prostate cancer screening compared to not screening

Types of screening

Screening for prostate cancer may include a combination of the following:

• Prostate Specific Antigen (PSA) is a blood test used to screen for prostate cancer. 
• During a Digital Rectal Exam (DRE) a doctor inserts a gloved, lubricated finger into the rectum to feel the prostate gland for enlargement or lumps.
• Clinical trials are looking at prostate screening using MRI imaging. 

Screening for high risk men

The National Comprehensive Cancer Network (NCCN) has guidelines for prostate cancer screening in men who are at high risk for prostate cancer due to an inherited mutation.

• African American men should consider annual screening with PSA and DRE beginning at age 40.
• Men with an inherited BRCA2 mutation, should begin annual screening with PSA and DRE at age 40.
• Men with an inherited BRCA1 mutation should consider annual screening with PSA and DRE beginning at age 40.
• There has not been enough research to show a benefit from early, or annual screening for prostate cancer in men who have an ATM, CHEK2, PALB2, NBN or other mutations linked to prostate cancer. For these men, experts recommend managing these risks based on family history of cancer.  

Men at high risk for prostate cancer should consider enrolling in a screening clinical trial. 

Screening for average risk men

There are several different guidelines for prostate cancer screening in average risk men:

• NCCN recommends beginning at age 45, men should have a conversation with their doctor about their risk for prostate cancer and the benefits, risks and limitations of prostate cancer screening using PSA and DRE.
  • For men who choose to undergo screening, PSA and DRE should be performed every 2-4 years as long as DRE is normal and PSA is low (<1 ng/ml).
  • For men with slightly elevated PSA of 1-3 ng/ml and normal DRE, screening should be repeated every 1-2 years. 
  • After age 75, screening every 1-4 years should be considered for healthy men. 
• The U.S. Preventive Services Task Force (USPSTF) recommends that men who are 55 to 69 years old should talk to their doctor about the benefits and harms of screening for prostate cancer and make their own decisions about being screened for prostate cancer with a prostate specific antigen (PSA) test.
  • Men who are 70 years old and older should not be screened for prostate cancer routinely.
• The American Cancer Society (ACS) recommends beginning at age 50, men should discuss the benefits, risks, and limitations of prostate cancer screening with their doctor in order to make an informed decision about whether to be screened for prostate cancer.
  • For men who choose screening, PSA and DRE should be performed every 2 years as long as DRE is normal and PSA is low (<2.5 ng/ml).
  • For men who choose screening, PSA and DRE should be performed every year if DRE is normal and PSA is 2.5 ng/ml or higher.

When an abnormality is found

If the prostate feels abnormal on DRE, or the PSA is high or rising over time, doctors will usually order a biopsy of the prostate. Doctors may also order imaging tests, such as MRI or additional biomarker tests.