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When Does Prostate Cancer Screening Start

Men: Cancer Screening Exams By Age

Prostate Cancer Early Diagnosis Screening

These exams are for men at average risk of cancer.

Take this checklist to your next doctors appointment. Your doctor can help you develop a more tailored screening plan if needed.

These exams are for men at average risk of cancer. If you believe you may be more likely to develop cancer because of your personal or family medical history, visit our screening guidelines page to learn about exams for men at increased risk.

Ages 40-49

  • Beginning at age 40, you should speak with your doctor about the benefits and limitations of prostate screening.
  • If you choose prostate cancer screening, you should get a digital rectal exam and PSA test every year starting at age 45 to check for prostate cancer if you are African American or have a family history of prostate cancer.

Ages 50-75

Age 76 and older

If youre age 76 to 85, your doctor can help you decide if you should continue screening. MD Anderson does not recommend cancer screening for men age 85 and older.

All Ages

Speak with you doctor about cancer screening exams for lung and skin cancers. Exams are available for those at increased risk.

Regardless of your age, practice awareness. This means you should be familiar with your body so youll notice changes and report them to your doctor without delay.

Screening For Prostate Cancer In Men With A Family History

Burden

The introduction of PSA-based screening for prostate cancer has substantially altered the epidemiologic data for prostate cancer, greatly increasing the number of men with a diagnosis of prostate cancer and thus also the number of men with a father, brother, or son with a history of prostate cancer.

Available Evidence

It is generally accepted that men with a family history of prostate cancer are more likely to develop prostate cancer. A study of twins in Scandinavia estimated that genetic factors may account for up to 42% of prostate cancer risk.18 An analysis from the Finnish site of the ERSPC trial concluded that men with at least 1 first-degree relative with prostate cancer were 30% more likely to be diagnosed with prostate cancer than men without a family history.19 Men with 3 first-degree relatives with prostate cancer or 2 close relatives on the same side of the family with prostate cancer diagnosed before age 55 years may have an inheritable form of prostate cancer associated with genetic changes passed down from one generation to the next. This type of prostate cancer is thought to account for less than 10% of all prostate cancer cases.20

The USPSTF searched for evidence about the potential benefits and harms of PSA-based screening for prostate cancer in men with a family history of prostate cancer.

Potential Benefits

Potential Harms

Advising Men With a Family History of Prostate Cancer

Response To Public Comment

A draft version of this recommendation statement was posted for public comment on the USPSTF website from April 11 to May 8, 2017. A number of comments suggested that because men are now living longer, they should be screened beyond 70 years of age. However, the USPSTF considered other evidence in addition to data on life expectancy when recommending against screening in men older than 70 years, including results from large screening trials that did not report a mortality benefit for men older than 70 years and evidence on the increased likelihood of harm from screening, diagnostic evaluation, treatment, overdiagnosis, and overtreatment. Several comments requested a recommendation for younger men and for baseline PSA-based screening in men 40 years and older or 50 years and older. The USPSTF found inadequate evidence that screening younger men or performing baseline PSA-based screening provides benefit.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Authors followed the policy regarding conflicts of interest described at . All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings.

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Permission To Use This Summary

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as NCIs PDQ cancer information summary about breast cancer prevention states the risks in the following way: .

The best way to cite this PDQ summary is:

PDQ® Screening and Prevention Editorial Board. PDQ Prostate Cancer Screening. Bethesda, MD: National Cancer Institute. Updated < MM/DD/YYYY> . Available at: . Accessed < MM/DD/YYYY> .

Images in this summary are used with permission of the author, artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

What Are The Risks Of Prostate Cancer Screening

How Prostate Cancer Is Diagnosed

A couple of the risks to discuss with your doctor are:

Overdiagnosis. This means you get diagnosed with a condition that wouldnât have caused symptoms or problems. Some prostate cancers grow so slowly that theyâd never give you problems during your lifetime. So, you could end up getting tests or treatments that you donât need.

False-positive test result. This is an incorrect result. It says you have a certain health condition when you actually donât. It could lead to follow-up tests that you donât need.

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How Often Should You Get Screened For Prostate Cancer

Again, the recommendations vary. Ask your doctor whatâs right for you if you decide to get screened.

The American Cancer Society says that if a screening test shows you donât have prostate cancer:

  • You may need to get retested every 2 years if your PSA blood test shows that your PSA level is less than 2.5.
  • You should get screened once a year if your PSA level is 2.5 or higher.

The American Urological Association recommends that you ask your doctor whether you should get screened every 2 years instead of once a year.

What Do My Psa Test Results Mean

Once your test results are back, your healthcare provider will let you know if any additional testing is recommended. PSA levels can vary over time for several reasons unrelated to prostate cancer . So, if you have a borderline PSA, your provider may simply recommend another PSA test in six months or so.

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What Have Randomized Trials Of Prostate Cancer Screening Found

Several large, randomized trials of prostate cancer screening have been carried out. One of the largest is the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, which NCI conducted to determine whether certain screening tests can help reduce the numbers of deaths from several common cancers. In the prostate portion of the trial, the PSA test and digital rectal exam were evaluated for their ability to decrease a mans chances of dying from prostate cancer.

The PLCO investigators found that men who underwent annual prostate cancer screening had a higher incidence of prostate cancer than men in the control group but had about the same rate of deaths from the disease . Overall, the results suggest that many men were treated for prostate cancers that would not have been detected in their lifetime without screening. Consequently, these men were exposed unnecessarily to the potential harms of treatment.

A second large trial, the European Randomized Study of Screening for Prostate Cancer , compared prostate cancer deaths in men randomly assigned to PSA-based screening or no screening. As in the PLCO, men in ERSPC who were screened for prostate cancer had a higher incidence of the disease than control men. In contrast to the PLCO, however, men who were screened had a lower rate of death from prostate cancer .

The United States Preventive Services Task Force has estimated that, for every 1,000 men ages 55 to 69 years who are screened for 13 years :

What Should I Expect During A Prostate Exam

Prostate Cancer Epidemiology, Screening and Diagnosis – 2021 Prostate Cancer Patient Conference

As mentioned above, there are two types of screenings that your healthcare provider may use to detect prostate cancer: a PSA blood test and a digital rectal exam . Research shows that the PSA blood test is more effective for detecting prostate cancer. However, the DRE can still find cancer in people with normal PSA levels. For this reason, many healthcare providers recommend both.

Neither test confirms you have prostate cancer, which is why theyre considered screening assessments rather than diagnostic tests.

PSA blood test

For this test, your healthcare provider simply draws a sample of your blood and sends it to a lab for analysis. The PSA blood test measures the amount of prostate-specific antigen in your blood.

There is no official cutoff score that can determine whether or not you have prostate cancer. Instead, the results are used as a gauge to determine if more testing is needed.

If you have a high PSA, you may need further testing such as a prostate biopsy, MRI or other lab tests to determine if prostate cancer may be present.

Digital rectal exam

During a DRE, your healthcare provider inserts a lubricated, gloved finger into your rectum. This way, they can feel your prostate to see if there are any lumps or bumps on the back portion of the gland .

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The Risks Of Prostate Screening Include The Following:

Finding prostate cancer may not improve health or help a man live longer.

Screening may not improve your health or help you live longer if you have cancer that has already spread to the area outside of the prostate or to other places in your body.

Some cancers never cause symptoms or become life-threatening, but if found by a screening test, the cancer may be treated. Finding these cancers is called overdiagnosis. It is not known if treatment of these cancers would help you live longer than if no treatment were given.

Treatments for prostate cancer, such as radical prostatectomy and radiation therapy, may have long-term side effects in many men. The most common side effects are erectile dysfunction and urinary incontinence.

Some studies of patients with newly diagnosed prostate cancer showed these patients had a higher risk of death from cardiovascular disease or suicide. The risk was greatest in the first weeks or months after diagnosis.

Follow-up tests, such as a biopsy, may be done to diagnose cancer.

If a PSA test is higher than normal, a biopsyof the prostate may be done. Complications from a biopsy of the prostate may include fever, pain, blood in the urine or , and urinary tractinfection. Even if a biopsy shows that a patient does not have prostate cancer, he may worry more about developing prostate cancer in the future.

False-negative test results can occur.

False-positive test results can occur.

Should You Know Your Psa Level

Instead of a national screening programme, there is an informed choice programme, called prostate cancer risk management, for healthy men aged 50 or over who ask their GP about PSA testing. It aims to give men good information on the pros and cons of a PSA test.

If you’re aged 50 or over and decide to have your PSA levels tested after talking to a GP, they can arrange for it to be carried out free on the NHS.

If results show you have a raised level of PSA, the GP may suggest further tests.

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Can I Check My Own Prostate

It is not recommended that you try to check your own prostate.

The prostate is an internal gland, and performing a self-examination could cause harm. For your safety, the exam should be performed by a licensed healthcare professional.

Additionally, a professional will be better able to assess if there is a reason for concern.

Prostate Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Prostate

Prostate Cancer

The prostate is agland in the malereproductive system located just below the bladder and in front of the rectum . It is about the size of a walnut and surrounds part of the urethra . The prostate gland produces fluid that makes up part of .

As men age, the prostate may get bigger. A bigger prostate may block the flow of urine from the bladder and cause problems with sexual function. This condition is called benign prostatic hyperplasia , and although it is not cancer, surgery may be needed to correct it. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms of prostate cancer.

See the following PDQ summaries for more information about prostate cancer:

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Current Evidence For Prostate Cancer Screening

Localized prostate cancer is asymptomatic. By the time symptoms become present, the disease is generally too advanced for cure. Indeed, one of the most common presentations of prostate cancer before the advent of screening was paralysis, related to spinal cord metastasis. Therefore, the concept of screening is particularly appealing for prostate cancer, as it provides an opportunity to identify the disease at a curable stage. This called for a test that could detect prostate cancer earlier, and led to the discoveries of the blood test prostate-specific antigen , first isolated and defined in the 1970s.24 Several screening studies in the late 80s-early 90s showed that the PSA-test could identify more prostate cancers at an organ-confined, clinically localized stage as compared to evaluations for palpable tumors by digital rectal examination, which set the stage for a widespread adoption of PSA-testing, particularly in the U.S. This resulted in a rapid surge in prostate cancer incidence.510

The age-specific prostate cancer mortality in the U.S. is down by 50% from peak rates due to PSA screening and improvements in treatment, but recently this trend has been flattening due to recommendations against PSA screening in previous years, mainly the 2012 United States Preventive Services Task Force guideline.10,22 Studies now document an increase in metastatic prostate cancer.2326

Prostate Cancer Screeningwhen To Start And How To Screen

Kimia Kohestani1,2, Marina Chilov3, Sigrid V. Carlsson1,4

1Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy at the University of Gothenburg , Memorial Sloan Kettering Cancer Center , 4Departments of Surgery and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center , , USA

Contributions: Conception and design: SV Carlsson Administrative support: SV Carlsson Provision of study material or patients: All authors Collection and assembly of data: All authors Data analysis and interpretation: SV Carlsson, K Kohestani Manuscript writing: All authors Final approval of manuscript: All authors.

Correspondence to:

Keywords: Prostate cancer screening baseline prostate-specific antigen

Submitted Dec 11, 2017. Accepted for publication Dec 20, 2017.

doi: 10.21037/tau.2017.12.25

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Why Is Prostate Cancer Screening Important

“The mortality rate of prostate cancer becomes much higher when it’s found late,” warns Dr. Miles. “Caught in the early stages, however, it’s a disease that’s easily treated, easily controlled though this does mean we need to find it before it’s progressed.”

And that’s where prostate cancer screening comes in, a way of detecting prostate cancer early before symptoms begin, when it’s most treatable. It helps reduce the chance of the cancer spreading or requiring aggressive treatment.

The Position Of The Patient

Prostate Cancer: Screening Process and Early Detection

Before explaining the procedure by which the rectal examination is carried out, we are going to tell you about the different positions you can take so that this test passes with maximum comfort, both for you and for the doctor. Normally, depending on your personal characteristics, the doctor will choose one or another position, although if necessary, he may also give you to choose the position in which you feel most comfortable. The three main positions the patient is usually in are:

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When Does Prostate Cancer Screening Start

Any man can develop prostate cancer, but some are higher risk.

Prostate cancer is most common in older men, with the average age at diagnosis being 67. For this reason, most men don’t need to start being screened for it until they’re over the age 50, Dr. Miles says.

“There are two factors that warrant screening earlier than this,” adds Dr. Miles. “If you’re African American or if you have a family history of prostate cancer, you’re considered higher risk and we recommend you start getting PSA tests done around age 40.”

Is The Psa Test Recommended For Prostate Cancer Screening

Beginning around 2008, as more was learned about both the benefits and harms of prostate cancer screening, a number of professional medical organizations began to caution against routine population screening with the PSA test. Most organizations recommend that individuals who are considering PSA screening first discuss the risks and benefits with their doctors.

Some organizations do recommend that men who are at higher risk of prostate cancer begin PSA screening at age 40 or 45. These include Black men, men with germline variants in BRCA2 , and men whose father or brother had prostate cancer.

In 2018, the United States Preventive Serves Task Force updated its recommendation statement for prostate cancer screening from a D to a C in men ages 55 to 69. The updated recommendation, which applies to the general population as well as those at increased risk due to race/ethnicity or family history, is as follows:

  • For individuals ages 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one. Before making the decision, a person should discuss the potential benefits and harms of screening with their clinician and consider these in the context of their own values and preferences.
  • PSA-based screening for prostate cancer is not recommended for individuals 70 years and older.

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