Priority Topic: Prostate

Key Feature 2: In a patient suitable for prostate cancer screening, use and interpret tests (ex: prostate-specific antigen testing, digital rectal examination [DRE], ultrasonography) in an individualized/sequential manner to identify potential cases.
Skill: Selectivity, Patient Centered
Phase: Investigation, Diagnosis

In a previous post I outlined that the Canadian Task Force on Preventative Health Care recommends prostate cancer screening only indicated for men who have a personal history of prostate cancer. There may be other circumstances in which we investigate for the possibility of prostate cancer in patients, but these would generally be based on their clinical presentation, and this is considered diagnostic testing at this point rather than screening, which is a term that is only used when looking for disease in patients who are asymptomatic for the disease being screened for.

When screening for prostate cancer is indicated, UpToDate recommends the following approach:

1. Screen with PSA every 2-4 years, deferring PSA testing while there are active issues that elevate PSA acutely (see table below).
2. DRE not recommended for screening purposes.
3. For a PSA between 4 and 7, repeat testing several weeks later. If PSA still >4, refer to a Urologist.
4. For a PSA >7, always refer straight away to a Urologist without performing additional investigations.