Recommendations on screening for prostate cancer with the prostate-specifi antigen test

• The prevalence of undiagnosed prostate cancer at autopsy is high and increases with age (> 40% among men aged 40-49 yr to > 70% among men aged 70-79 yr)

• Only a small proportion of men with prostate cancer have symptoms or die from the disease; most prostate cancers are slowly progressive and not life threatening.

• Screening with the PSA test may lead to a small reduction in prostate cancer mortality but not a reduction in all-cause mortality.

• Thresholds for PSA of 2.5 to 4.0 ng/mL are commonly used for screening; lower thresholds increase the probability of false-positive results, and no threshold completely excludes prostate cancer.

• Harms associated with PSA screening (e.g., bleeding, infection, urinary incontinence, a false-positive result and overdiagnosis) are common.

• The PSA test should not be used for screening without a detailed discussion with the patient, ideally with the use of decision aids to facilitate comprehension.