Guidelines

The American Cancer Society and the American Urological Association recommend an annual PSA test beginning at age 50. Men at increased risk for prostate cancer—black men and men with a family history of the disease—should begin annual screening at age 40 to 45. A recent study found that testing all men at age 40, age 45, and then every other year after age 50 may be a better strategy—it saved more lives and was less expensive. Another recent study suggests that men age 50 and older who have PSA levels below 2 ng/mL do not need annual testing.

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A number of factors may affect the results of a PSA test. For example, some studies show that ejaculation one or two days before a PSA test may increase PSA levels in the blood. Consequently, men should abstain from sex for two days prior to a PSA test. Digital rectal exams and biopsies of the prostate may also affect PSA levels, though the increase in PSA caused by a digital rectal exam is not thought to be significant enough to result in a false-positive test result. In addition, other prostate problems (such as benign prostatic hyperplasia or prostatitis) can inflate PSA levels, and BPH medications (such as finasteride and dutasteride) can lower PSA levels by about 50 percent.