Prostate Cancer Screening Recommendations

Evolution of Guidelines

The American College of Physicians found that the 2008 USPSTF guideline recommended against screening for men ≥75 years (Grade D) and had insufficient evidence for men <75 years (I statement) 1, 2, 3
The USPSTF revised its recommendation in 2012 to recommend against PSA-based screening for all age groups (Grade D recommendation) 4, 5
The 2018 USPSTF guideline revision reflects updated evidence from randomized trials showing a small mortality benefit in the 55-69 age group, balanced against substantial treatment harms 6

Pain and discomfort from prostate biopsies can occur 7
Many men with screen-detected cancer would never have developed symptoms during their lifetime (overdiagnosis), yet experience treatment complications 7

The USPSTF acknowledges that African American men have higher rates of aggressive prostate cancer and may derive greater benefit from screening than the general population 6
Men with a first-degree relative who had advanced prostate cancer at diagnosis, developed metastatic disease, or died from prostate cancer are likely to benefit more from screening 6

The American Urological Association and American Cancer Society support earlier initiation of screening (ages 45-50) with risk stratification 8
The American Cancer Society recommends beginning screening discussions at age 45 for African American men and men with one affected first-degree relative diagnosed before age 65 8