Prostate Cancer Early Detection Flowchart

This chart shows the National Cancer Center Network Guidelines, 2014, for use of the PSA test and Digital Rectal Exam (DRE) for early detection of prostate cancer. Recommendations for men over age 70 are below the chart. prostate-cancer-early-detection-chart-png

If PSA is suspicious, a set of further blood tests should be recommended. Digital rectal exam (DRE) should not be used as a stand-alone test, NCCN says. Rather, it should be considered as a baseline test in all patients as "it may identify high-risk cancers associated with 'normal' serum PSA values." Further, DRE should be performed in men with an elevated PSA.

PSA testing for men above age 70

NCCN panelists all agreed PSA testing should only be offered to men with a 10 or more year life expectancy. Of course, individuals differ in their overall health and life expectancy. In view the wide array of possible differences in mind, the panelists did not agree as to when to discontinue routine testing in "asymptomatic" older men (men free of signs or symptoms of prostate problems). They summarized their views as follows:

  • one strategy to reduce over-diagnosis in the older population would be to discontinue screening at age 69 years
  • a second would be to continue screening up to age 74 years but increase the PSA threshold for biopsy among men aged 70 to 74 years
  • a third would be to discontinue screening at age 75 years for men with PSA < (below) 3.0 ng/m."


NCCN Guidelines for Prostate Cancer Patients 2012

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NCCN Patient & Caregiver Resources

NCCN Guidelines for Prostate Cancer Early Detection, 2014 (requires log-in).