What are the NCCN prostate cancer screening guidelines?

Updated: Jul 31, 2017
  • Author: Bagi RP Jana, MD; more...
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The NCCN recommends performing a baseline evaluation, with a history and physical examination that includes the following:

  • Family history
  • Medications
  • History of prostate disease and screening, including prior PSA and/or isoforms, exams, and biopsies
  • Race
  • Family or personal history of BRC1/2 mutations

The clinician should then discuss of the risks and benefits of a baseline PSA test with the patient, and consider a baseline DRE to identify high-risk cancers associated with a seemingly normal PSA. In patients 45-75 years of age, subsequent evaluation is based on the results of those tests, as follows [10] .

  • PSA
  • PSA 1-3 ng/mL, DRE normal (if done): Repeat testing at 1–2 year intervals
  • PSA >3 ng/mL or very suspicous DRE result: Evaluate for biopsy
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    For men above the age of 75, screening may be cautiously considered in selected cases of very healthy men with little or no comorbidity. If PSA is measured and is 4 ng/mL or DRE results are very suspicious, the patient should be evaluated for biopsy.

    The NCCN notes that men ≥60 years of age with serum PSA <1.0 ng/mL have a very low risk of metastasis or death from prostate cancer and may not benefit from further testing. The same is true of men age 75 years with a PSA of <3.0 ng/mL.

    Evaluation for biopsy includes the following:

    • Repeat PSA
    • Perform DRE, if not done performed during initial risk assessment
    • Workup for benign disease

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