- Men ages 50 to 70 should be offered annual screening. (Some experts believe that men whose PSA levels are under 1.0 and possibly under 2.0 may safely be screened only every two years thereafter.)
- Men with a family history of prostate cancer and all African-American men should consider annual screening at about age 45.
The best age to start annual screening is under debate. Some experts advocate performing a first PSA test in all men aged 40 and then monitoring anyone whose PSA levels are over 0.60 ng/mL. They argue that such men are at high risk for developing prostate cancer within 25 years.
Accuracy of Screening Tests |
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DRE alone |
PSA alone and in Combination with DRE |
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Chance of Cancer |
Only 20% of men with abnormal DREs have cancer. Unfortunately, 70% of prostate cancers detected with DRE alone have already spread beyond the prostate gland. |
The odds of cancer with PSA readings are the following:
Men who with abnormal results from both DRE plus PSA tests have a 60% chance for cancer. |
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Risk of Missed Cancers with Normal Results |
About 60% of men who have prostate cancer have normal DRE results. |
Some evidence suggests that only performing biopsies at levels above 4.0 would miss over 80% of cancers present below that level in men under 60 years and 65% in older men. As a result, some experts recommend biopsies with PSA levels at 3.0 or below in young men. Still, cancer at low PSA levels is very uncommon, particularly in younger men. |
Digital Rectal Exam (DRE)
About 90% of all prostate cancers arise in the outer part of the prostate where they may be detected by a digital rectal exam (DRE), which is the simplest and most widely-performed screening procedure. The doctor inserts a gloved and lubricated finger into the patient's rectum and feels the prostate for bumps or other abnormalities. The exam is quick and painless but some men find it embarrassing. It is not very accurate in detecting early cancers, but studies indicate that regular DREs still save lives.
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