Prostate Cancer Screening

The Gold Standard for screening for prostate cancer is the rectal exam and the PSA blood test (Prostate Specific Antigen). However, the PSA test is quite controversial. No organization recommends screening of the population with the PSA test, but rectal exams are recommended for the population. What is recommended about PSA tests is that you discuss them with your doctor and decide whether they would be useful for you.

How do you decide if a PSA test would be useful? The first question is, do you come from a family where your risk might be increased based on having a history of prostate cancer in your brothers or father?

Low Risk: defined as a man with no first degree relatives (brother or father) who have a history of prostate cancer.
Medium Risk: defined as a man with one first degree relative (brother or father) who has a history of prostate cancer.
High Risk: defined as a man with more than one first degree relative (brothers and/or father) who have a history of prostate cancer.

Once you answer this question, you have to use the information from the following tables to get a sense for what a PSA level will accomplish and at what risk.

Outcomes for Men at Low Risk of Familial Prostate Cancer who are Screened with PSA Levels Yearly (out of 1000 men)
Outcome Type Events Over 10 Years	Screen for 45 years, begin at Age 40	Screen for 35 years, begin at Age 50	Screen for 25 years, begin at Age 60	Screen for 15 years, begin at Age 70
Death by Age 85 years	639	632	614	561
Die of Prostate Cancer	28	28	29	26
Die of Non-Prostate Cancer	611	603	585	534
Have Prostate Cancer Diagnosed (within 10 years)	<1	10	53	91
Have Prostate Cancer Diagnosed on PSA Screen (within 10 years)	<1	5	28	68
Number of Biopsies likely to be performed due to abnormal PSA (within 10 years)	1	22	115	280
Number of Biopsies performed on falsely positive PSA levels (within 10 years)	<1	16	87	211

Outcomes for Men at Low Risk of Familial Prostate Cancer who are not Screened with PSA Levels Yearly (out of 1000 men)
Death by Age 85 years	640	633	615	564
Die of Prostate Cancer	30	31	31	32
Die of Non-Prostate Cancer	610	602	584	533
Have Prostate Cancer Diagnosed (within 10 years)	<1	4	23	57

Outcomes for Men at Medium Risk of Familial Prostate Cancer who are Screened with PSA Levels Yearly (out of 1000 men)
Outcome Type	Screen for 45 years, begin at Age 40	Screen for 35 years, begin at Age 50	Screen for 25 years, begin at Age 60	Screen for 15 years, begin at Age 70
Death by Age 85 years	665	658	641	586
Die of Prostate Cancer	68	69	71	64
Die of Non-Prostate Cancer	597	589	570	523
Have Prostate Cancer Diagnosed (within 10 years)	1	24	129	218
Have Prostate Cancer Diagnosed on PSA Screen (within 10 years)	<1	13	67	166
Number of Biopsies likely to be performed due to abnormal PSA (within 10 years)	3	54	281	666
Number of Biopsies performed on falsely positive PSA levels (within 10 years)	2	41	212	500

Outcomes for Men with a Medium Risk of Familial Prostate Cancer who are not Screened with PSA Levels Yearly (out of 1000 men)
Death by Age 85 years	667	660	644	594
Die of Prostate Cancer	72	74	76	77
Die of Non-Prostate Cancer	595	586	568	518
Have Prostate Cancer Diagnosed (within 10 years)	<1	11	57	138

Outcomes for Men at High Risk of Familial Prostate Cancer who are Screened with PSA Levels Yearly (out of 1000 men)
Outcome Type Events Over 10 Years	Screen for 45 years, begin at Age 40	Screen for 35 years, begin at Age 50	Screen for 25 years, begin at Age 60	Screen for 15 years, begin at Age 70
Death by Age 85 years	704	697	682	623
Die of Prostate Cancer	128	131	135	122
Die of Non-Prostate Cancer	575	566	547	503
Have Prostate Cancer Diagnosed (within 10 years)	3	47	249	408
Have Prostate Cancer Diagnosed on PSA Screen (within 10 years)	1	26	134	316
Number of Biopsies likely to be performed due to abnormal PSA (within 10 years)	6	107	543	1232
Number of Biopsies performed on falsely positive PSA levels (within 10 years)	5	81	409	916

Outcomes for Men at High Risk of Familial Prostate Cancer who are not Screened with PSA Levels Yearly (out of 1000 men)
Death by Age 85 years	707	701	686	640
Die of Prostate Cancer	137	140	144	145
Die of Non-Prostate Cancer	570	561	542	495
Have Prostate Cancer Diagnosed (within 10 years)	1	21	113	266

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