Prostate Cancer Screening Guidelines

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.

• Black 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 ATM, BRCA1 or CHEK2 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 EPCAM, HOXB13, MLH1, MSH2, MSH6, NBN, PALB2, 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.