Prostate cancer screening (PSA)

• USPSTF 2018: ages 55 to 69, an individual decision after discussing benefits and harms (Grade C). Age 70 and older: do not screen (Grade D).
• AUA and SUO: offer screening at 50 to 69 after shared decision-making; begin at 40 to 45 for Black men, men with germline mutations such as BRCA2, or a strong family history. A baseline PSA at 45 to 50 can set the interval.
• American Cancer Society: start the discussion at 50 for average risk with a 10-year life expectancy, at 45 for Black men or one first-degree relative diagnosed before 65, and at 40 for more than one relative diagnosed young.

• PSA blood test; a digital rectal exam alone is not enough for screening and may be added. Interval 2 to 4 years (AUA), longer with a PSA under 1.0 ng/mL. The ACS suggests every 2 years with a PSA under 2.5 ng/mL and yearly at 2.5 or higher.
• Repeat an elevated PSA before acting on it, after any infection has settled, and with no ejaculation or cycling in the prior 48 hours.
• Before a first biopsy, the AUA says MRI may be used to find more grade group 2 or higher cancers, and blood or urine markers such as PHI or 4Kscore may be added when the result would change the biopsy decision (both conditional recommendations).
• Stop when life expectancy is under 10 years. USPSTF says stop at 70; the AUA leaves the stopping age to shared decision-making and says screening may stop, or the interval lengthen, at 75 or older with a PSA under 3 ng/mL.
• A low-risk cancer that is found goes to active surveillance as the preferred approach (AUA 2022), so a screening decision no longer implies treatment.

USPSTF 2018 moved ages 55 to 69 from a recommendation against (2012) back to an individual decision. The AUA 2023 guideline, kept in its 2026 amendment, pushed risk-adapted starting ages and intervals and made MRI before a first biopsy an option.

• Finasteride and dutasteride halve the PSA. Double the measured value in anyone taking them.
• The USPSTF numbers for the conversation: for every 1,000 men aged 55 to 69 screened for about 13 years, roughly 1 prostate cancer death and 3 cases of metastatic disease are prevented, at the cost of about 240 positive PSA results, about 220 men biopsied (fewer with current U.S. practice), and 100 cancers diagnosed, of which 20 to 50 percent would never have caused symptoms.
• Document the shared decision and the chosen interval; the interval is where most over-screening happens.

• Colorectal cancer screening
• Cervical cancer screening
• Breast cancer screening
• Lung cancer screening