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Prostate Cancer Screening Recommendations

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Alan J. Wein, MD
Last Modified: November 1, 2001

Dear OncoLink "Ask the Experts,"
Since free PSA tests are usually used in patients with total PSA values >4.0, what is the significance of a total value of <4.0 (2.8 in my case) with a free PSA of 15%? What type of screening would you recommend?

Alan J. Wein, MD, Professor and chair of the Division of Urology at the University of Pennsylvania School of Medicine and Chief of Urology at the Hospital of the University of Pennsylvania, responds:

There is no significance of a PSA of 2.8 with a free PSA of 15%. Prostate cancer is rarely seen in men younger than 50 years old. The chance of developing prostate cancer increases as men get older. So, if you are over 50, you should continue to have a PSA yearly. Black males are more likely to develop prostate cancer than white males. Black males are also more likely to die of prostate cancer than white males. So, if you are over 40 years old and African American, you should continue to have a PSA yearly.

Family history of prostate cancer is also a significant factor when screening. A man whose father, brother, or son has had prostate cancer has a higher-than-average risk of developing prostate cancer. So, if you are over 40 with a first-degree relative who had prostate cancer, you should continue to have a PSA yearly.

The only exceptions to the above recommendations would be:

• Your PSA has gone up >0.7 units in the 12 months prior to the 2.8
• Your digital rectal exam was abnormal.