Prostate Cancer Early Detection:
2023 National Comprehensive Cancer Center Network Guidelines
Dr. Catalona is a member of the National Comprehensive Cancer Center Network (NCCN) Early Prostate Cancer Detection Guideline Panel. In a recent article on which Dr. Catalona is a co- author, the NCCN Panel recommends that men should review with their physicians their family history of cancer, family or personal history of high-risk genetic mutations (e.g., BRCA2 mutations) that predispose to cancer, their history of prostate disease, their previous cancer early detection measures (PSA and prostate biopsies), their racial identity (e.g., Black/African American), medications, and environmental exposures (Agent Orange, fertilizers, etc.). They should start a risk and benefit discussion about whether they wish to undergo prostate cancer early detection (baseline PSA and consider a finger rectal exam of the prostate (DRE- digital rectal examination). If they wish to pursue early detection testing, those aged 45-75 years with average risk for prostate cancer, or those with high risk (e.g., Black, high-risk genetic mutations, suspicious family history of prostate cancer), are recommended to have a PSA blood test. If they are average risk and their PSA level is less than 1 ng/mL and DRE is normal, repeat testing at 2- to 4-year intervals is suggested. However, if their PSA is 1-3 ng/mL, repeat testing is recommended at 1- to 2-year intervals. If they are high risk and their PSA is 3 ng/mL or less and the DRE (if done) is normal, repeat testing at 1- to 2-year intervals is recommended. If their PSA is higher than 3 ng/mL and or their DRE is suspicious for cancer, an MRI scan, genomic testing, and/or a prostate biopsy should be considered. For men over 75 years old or older with a reasonable life expectancy, if the PSA is less than 4 ng/mL, repeat testing at 1- to 2- year intervals is recommended. If their PSA is higher than 4 ng/mL ng/mL and/or the DRE is suspicious for cancer, MRI scan, genomic testing, and prostate biopsy should be considered. If they have significant other life- threatening conditions and/or their life expectancy is limited, screening is not recommended.
J Natl Compr Canc Netw. 2023 Mar;21(3):236- 246. doi: 10.6004/jnccn.2023.0014.PMID: 36898362