What are the NCCN guidelines on prostate cancer screening?

Updated: Jan 14, 2019
  • Author: Lanna Cheuck, DO; Chief Editor: Edward David Kim, MD, FACS  more...
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The National Comprehensive Cancer Network (NCCN) notes the importance of identifying aggressive prostate cancer while avoiding the detection of indolent disease. For men 45-75 years old, the NCCN recommends a discussion of screening risks and benefits, followed by a baseline PSA and consideration of a DRE, especially in men with an elevated PSA level. [3]

The NCCN recommends basing repeat testing intervals on PSA and DRE findings, as follows:

  • PSA < 1 ng/mL, DRE normal (if done) – 2-4 years
  • PSA 1-3 ng/mL, DR normal (if done) – 1-2 years

For patients with PSA levels above 3 ng/mL or very suspicious DRE results, the NCCN recommends repeat PSA, DRE, and workup for benign disease. Considerations regarding transrectal ultrasound (TRUS)–guided biopsy should take into account the correlation between PSA levels and the likelihood of finding prostate cancer on biopsy, which is as follows:

  • PSA ≤4 ng/mL – 15%
  • PSA 4-10 ng/mL – 30-35%
  • PSA >10 ng/mL - >67%

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