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A Practical Approach to the Canadian Urological Association

                Recommendations on Prostate Cancer Screening and Early Diagnosis                                        1





      The CUA Prostate Cancer Screening Pathway                                           Best Screening Practices


                                                                         For men electing to undergo PSA screening, initiate PSA testing at age 50 in most
           Prostate cancer screening shared decision-making (ages 50–70)
                                                                         men and at age 45 in men at increased risk of prostate cancer (LoE, 3; GoR, C).
                                                                         Men with risk factors for prostate cancer (i.e., family history, black men) may benefit
                                                                         from PSA screening at an earlier age. For men with known germ-line mutations associated
                                                                         with prostate cancer development, an individualized testing strategy after consultation with
                                                                         a clinical geneticist is most appropriate.

          PSA <1 ng/ml         PSA 1–3 ng/ml         PSA >3 ng/ml
                                                                                     For men electing to undergo PSA screening

                                                                           Intervals between testing should be   The age at which to discontinue PSA
                                                                           individualized based on previous    screening should be based on current
          Repeat testing       Repeat testing      More frequent PSA       PSA levels.                     PSA level and life expectancy.
          every 4 years a,b     every 2 years a         testing c          • For men with PSA <1 ng/ml, repeat PSA    • For men aged 60 with a PSA <1 ng/ml,
                                                                             testing every 4 years (LoE, 3; GoR, C)    consider discontinuing PSA screening
                                                             PSA elevated  • For men with PSA 1–3 ng/ml, repeat PSA      (LoE, 2; GoR, C).
                                                                             testing every 2 years (LoE, 3; GoR, C)  • For all other men, discontinue PSA
      a Discontinue screening if life expectancy <10 years                                                   screening at age 70 (LoE, 2; GoR, C).
                                                   Consider adjunctive     • For men with PSA >3 ng/ml, consider
      b Consider discontinuation of screening if age >60    strategies d     more frequent PSA testing intervals    • For men with a life expectancy <10 years,
       and PSA <1 ng/ml                                                      or adjunctive testing strategies (LoE, 4;       discontinue PSA screening (LoE, 4; GoR, C).
                                                                             GoR, C)
      c More frequent testing interval can be considered;    Abnormal
       the optimal frequency is unknown
      d i.e., risk calculators, % free PSA, etc.     Biopsy shared       As baseline PSA levels rise above 1 ng/ml, the intermediate-term risk of developing prostate
                                                                                               2-4
      e Consider urology referral                   decision-making e    cancer increases substantially.  It is recommended that physicians take into account a
                                                                         patient’s general health status and competing risks of mortality when considering whether
                                                                         or not to offer PSA testing.


      Abbreviations: GoR: grade of recommendation; LoE: level of evidence; PSA: prostate-specific antigen.
      References: 1. Mason RJ, et al. Can Urol Assoc J 2022;6:E184-96 2. Preston MA, et al. J Clin Oncol 2016;34:2705-11. 3. Gelfond J, et al. J Urol 2015:194:46-51. 4. Vickers AJ, et al. BMJ 2013;346:f2023.
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