Annual screening should be offered at age 40 to men at high risk for prostate cancer. Many experts recommend that men 50 years of age and over receive individualized counseling about the known risks and possible benefits of PSA testing. The benefits of one-time or repeated screening and aggressive treatment of prostate cancer have not yet been proven. The potential benefit of PSA screening is decreased mortality from prostate cancer that is discovered early, but there are no data to show that PSA testing decreases mortality from prostate cancer. The probability that further invasive evaluation will be required as a result of testing is relatively high.
Aggressive therapy is necessary to realize any benefit from the discovery of a tumor.
Radical prostatectomy, radiation therapy, or both in combination have not been proven to be superior to watchful waiting for ized disease. Early detection may save lives and may avert future cancer-related illness. Some authorities recommend varying the strategy for follow-up of a positive PSA depending on the degree of elevation. Four methods have been proposed to improve the accuracy of PSA testing. Age-adjusted PSA cutoffs have also been advanced to address mean PSA increases with age.