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Last Updated: 8/17/2015  

Screening for Prostate Cancer

  • The natural history of untreated prostate cancer is variable, with certain subsets of patients living for extended periods of time without active treatment intervention.

  • Black men and men with a first-degree relative with the disease are more likely to develop prostate cancer.

  • Screening tests such as the PSA, or the DRE plus PSA, may detect prostate cancer before clinical symptoms of prostate cancer develop.

  • Treatment (including surgery and radiation treatments) for prostate cancer detected from screening programs may have adverse effects that decrease overall quality of life for men so treated; evidence is controversial as to whether survival is improved.

  • Disease-specific mortality is lower for men with clinically detected or palpable-on-DRE prostate cancer who undergo radical prostatectomy compared with watchful waiting, but it is uncertain whether this benefit extends to screen-detected disease.

  • There is conflicting data regarding prostate cancer mortality improvement from PSA-based testing.

  • Inform average-risk men aged 50 to 69 years of the potential benefits and harms of screening and use PSA to screen only those who express a preference to be screened. Do not screen most men over 69 years or those with life expectancy of less than 10 to 15 years.

  • There is continued controversy regarding prostate cancer screening due to weaknesses in the randomized trials and the challenges of balancing a potential mortality benefit against the potential for overtreatment, which may lead to harms such as erectile dysfunction and incontinence.

DOI: 10.7326/s241
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Author(s) and Disclosures:
Marc B. Garnick, MD has nothing to disclose. Mark J. Mann, MD has nothing to disclose. Costas D. Lallas, MD has nothing to disclose.

One or more of the present or past ACP Smart Medicine physician editors worked on this module and had nothing to disclose: Davoren Chick, MD, FACP; Deborah Korenstein, MD, FACP; Marjorie Lazoff, MD, FACP; Richard Lynn, MD, FACP.

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