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Screening for disease refers to medical evaluation and testing to determine the presence of a disease or a risk factor for a disease, typically among asymptomatic persons (those who do not already manifest symptoms of disease). The goal of screening is early detection allowing for either earlier diagnosis, treatment, or prevention.

The American Cancer Society recommends annual prostate specific antigen (PSA) and digital rectal examination (DRE) screening starting at the age of 50 years for all men with life expectancy of 10 or more years. Prostate specific antigen (PSA) is a protein produced by the prostate gland and can be detected by a simple blood test. Higher than normal levels of PSA in the bloodstream (between 4 to 10 ng/mL) are considered suspicious for prostate cancer. Levels of PSA above 10 ng/mL dramatically increase the likelihood of prostate cancer. The PSA level together with the digital rectal examination (DRE) are the most commonly used screening tests for prostate cancer.

Men at high risk, including African Americans and those with a first-degree relative (i.e., father or brother) affected by prostate cancer, should be screened starting at age 45. Those with multiple first-degree relatives with a history of prostate cancer should be tested starting at age 40.

There is considerable debate among experts regarding the benefits of routine screening for prostate cancer for all men in general. Because the progression of prostate cancer is unpredictable, it is difficult to determine whether a malignancy, once identified, would necessarily progress to the point of causing symptoms. Identification of small tumors may lead to unnecessary treatments with associated burden and complications.

The United States Preventive Services Task Force Recommendations on Screening for Prostate Cancer

The United States Preventive Services Task Force (USPSTF) is a group of health experts that periodically reviews published research about various medical issues and makes recommendations about preventive health care. The USPSTF last issued its recommendations about screening for prostate cancer in 2002. In an article published in the Annals of Internal Medicine in August 2008 (Volume 149; Issue 3; pp. 185-191), the USPSTF issued an update to its 2002 recommendations regarding the issue of screening for prostate cancer based on new information that has become available since 2002.

Before summarizing the updated USPSTF recommendations about prostate cancer screening, it would be helpful to review some of the major issues and problems associated with screening and treatment of prostate cancer.

• PSA Screening Test - The prostate-specific antigen (PSA) test has been widely used to screen men for prostate cancer since the mid-1990's. In many cases, the PSA test can detect prostate cancer before clinical symptoms develop and the PSA test is more sensitive than the digital rectal examination (DRE) for detecting prostate cancer. A PSA value of 4.0 ng/mL or higher is considered abnormal and suggests the possibility of prostate cancer. An abnormal PSA test, however, does not necessarily mean that prostate cancer is actually present. The only way to tell for sure if a man has prostate cancer is to perform a prostate biopsy and examine the tissue under a microscope for cancer cells to confirm or rule-out prostate cancer. Although prostate biopsy is generally considered to be a low-risk and safe procedure, in some cases complications may develop which include: