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PSA Screening Guidelines

Since prostate cancer is now the most common cancer found in American men behind skin cancer—and sits behind only lung cancer as the second leading cause of cancer death in men—it’s critical to stay up-to-date on the latest PSA screening guidelines.

While screening with a PSA test can lessen the number of deaths related to prostate cancer, it also allows for proper diagnosis and treatment; not all prostate cancers are equal. In fact, many men afflicted with prostate cancer detected by the PSA test are treated, even though their cancer is not aggressive. Since some treatments can lead to urinary and sexual function issues, the benefits and risks must be weighed properly.

At Onslow Urology Associates, we abide by the guidelines as follows:

1. Many men with prostate cancer do not need to be treated and can be followed by active surveillance. A diagnosis of prostate cancer is information used to help make decisions, not an indication for immediate treatment.

2. Compliance with screening will increase if men are told whether they are at high, intermediate, or low risk and are informed about their need for subsequent screening.

3. There is a balance between the harms and benefits of screening. By focusing screening on men at the highest risk of life-threatening prostate cancer, we can better achieve this balance.

Our doctors recommend the following screening guidelines for men expected to live at least 10 years:

  • Men aged 45–49 should have a baseline PSA test.
    • If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
    • If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every 2-4 years.
    • If the PSA level is less than 1 ng / mL, men should see their doctor for another PSA test at age 51–55.
  • Men aged 50–59 should have their PSA level checked.
    • If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
    • If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every 2-4 years.
    • If the PSA level is less than 1 ng / mL, men should see their doctor for another PSA test at age 60.
  • Men aged 60–70 should have their PSA checked.
    • If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
    • If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every 2-4 years.
    • If the PSA level is less than 1 ng / mL, no further screening is recommended.
  • Men aged 71–75 should talk with their doctor about whether to have a PSA test. The decision whether to have a PSA test should be based on past PSA levels and health of the man.
  • For men aged 76 or older, prostate cancer screening is not recommended.

In closing, a high PSA level does not generally mean that a man should have a prostate biopsy. A doctor will often repeat the PSA test after a few months to determine if it is still high and investigate whether there is a reason other than cancer that could explain why the PSA level is elevated.

These guidelines were adapted from James Eastham, Chief of the Urology Service at Memorial Sloan-Kettering Cancer Center; Andrew Vickers, a statistician in the Department of Epidemiology and Biostatistics; Hans Lilja, from the Departments of Laboratory Medicine and Surgery, and an investigator on the European Randomized Study of Prostate Cancer screening (ERSPC); and Peter Scardino, Chair of the Department of Surgery.