The recommended baseline evaluation includes considering a man's family cancer history, history of prostate disease and screening such as earlier PSA results, race, and family or personal history of high-risk germline genetic mutations. Any of these factors could impact a man's risk of developing prostate cancer, and thus can be used to guide early detection decisions.
For men 45-75 years old, the NCCN guidelines recommend different screening intervals based on prior PSA results. With a PSA below 1 ng/mL and a normal DRE, the NCCN guidelines suggest repeat testing every 2-4 years. For men with a PSA between 1-3 ng/mL or a normal digital rectal exam (DRE), the NCCN recommends repeat testing every 1-2 years. For men with a PSA over 3 ng/mL or a very suspicious DRE, the guidelines suggest reviewing indications for a biopsy.
For men older than 75 years who elect to undergo screening with a PSA or DRE, the NCCN suggests repeat testing every 1-4 years for patients with a PSA at or below 4 ng/mL. With a PSA higher than that, or a very suspicious DRE, a biopsy may be indicated.
The NCCN guidelines are important because many health insurance companies determine coverage based on the NCCN panel recommendations.