Discontinuation of PSA Screening for Prostate Cancer

Age-Based Recommendations

The US Preventive Services Task Force (USPSTF) explicitly recommends against PSA-based screening for prostate cancer in men 70 years and older (Grade D recommendation) 1
Multiple guidelines, including those from the American College of Physicians, recommend against screening in men aged ≥70 years 1
The benefits of screening are only observed in men up to 70 years of age in major randomized controlled trials 2, 3

PSA screening should only be offered to men with a life expectancy of at least 10 years, regardless of age 2, 4
Men with significant comorbidities and reduced life expectancy are unlikely to benefit from PSA screening but still face all the potential harms 5

For men aged 70-74 years who are very healthy with minimal comorbidities, PSA testing may be individualized but should be approached with caution 2, 5
If screening is continued in this age group, consider increasing the PSA threshold for biopsy to reduce overdiagnosis while maintaining cancer detection 2, 6
A microsimulation model showed that decreasing the screening stopping age from 74 to 69 years would lead to a 27% reduction in lives saved but an almost 50% reduction in overdiagnosis 7

Men aged 75 years or older with a PSA level less than 3.0 ng/mL are unlikely to die from prostate cancer and may safely discontinue screening 2, 6, 8
In the Baltimore Longitudinal Study of Aging, no men aged 75-80 years with PSA less than 3.0 ng/mL died of prostate cancer 9, 8
Men with PSA levels below median (<1 ng/mL) at age 60 have only a 0.5% risk of metastases and 0.2% risk of prostate cancer death 9

Overdiagnosis is particularly problematic in older men, as many will harbor cancers that would never affect their life expectancy 5, 8
Routine screening in men over 70 substantially increases rates of overdetection 8

The goal of refined testing beyond age 70 years should be to maximize reduction in overdiagnosis while minimizing impact on cancer-specific mortality 2
The National Comprehensive Cancer Network (NCCN) panel agrees that very few men older than 75 years benefit from PSA testing 8