PSA Test – do you need it?

The PSA test is the first step in the early detection of prostate cancer.

As such it must be used as part of a skilled diagnostic process and selective treatment process. When to start and stop screening, at what intervals to conduct screening, and when to biopsy are among questions we look at here.

Guidelines from the National Comprehensive Cancer Network suggest:

Age to start testing

Most of the NCCN panel advised PSA testing:

  • Starting at ages 45 to 50 years
  • With yearly or two-yearly follow up tests for men with PSA above the median for their age
  • Retesting at age 50 for those below the median

Median PSA levels related to age

  • 0.7 ng/mL for ages 40 to 49
  • 0.9 ng/mL for ages 50 to 59

Warning flag: PSA 1.0 or above

PSA assays have become more sensitive in recent decades. And more results of early detection have been gathered and analyzed. One upshot is, the PSA levelĀ  considered "normal" today is lower than a generation ago.

NCCN's latest guidelines recommend annual or biannual follow-up for men who have a PSA value above or equal to 1.0 ng/mL. This is above the 75th percentile for younger men (below 50 years). In other words, 75 out of 100 in men younger than age 50 have PSA below the 1.0 ng/mL. threshold.