The ACS guideline updates recommendations for men who choose to be screened. The principal PSA thresholds are unchanged. When blood levels exceed 4.0 ng/mL, further evaluation, perhaps including biopsy, “remains a reasonable approach.”

Between 2.5 ng/mL and 4.0 ng/mL, such evaluation should be considered, based on an assessment of the man’s risk that takes into account such factors as age, race, family history, abnormal DRE and results on previous biopsies.

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As before, the guideline does not recommend biopsy based on PSA velocity alone independent of the PSA score.

In a change from previous recommendations, the authors suggest that the screening interval may be extended from one to two years for men whose PSA is <2.5 ng/mL. Based on data from various studies, this approach would not add appreciably to mortality and would reduce unnecessary biopsies along with unnecessary testing.

Once considered a routine part of screening, DRE is now optional, to be considered on an individual basis (e.g., when PSA falls between 2.5 ng/mL and 4.0 ng/mL). Even with “optimal performance,” studies have found that DRE appears to increase cancer detection by relatively little.

“It is clear that cultural issues make DRE problematic for some men,” Brooks said, and this might deter those who would otherwise opt for screening. “It seems an unreasonable, unnecessary barrier.”

Community-based screening

Although community programs may provide a useful opportunity to those who otherwise would not have access to screening, these initiatives too often lack the resources for proper risk assessment and informed decision making or the means to assure appropriate counseling and follow-up care when results are positive. In their absence, the ACS discourages men from participating in such programs.

More generally, screening by a primary-care provider is a better choice than even well-conducted community programs, according to the ACS guideline authors.

Carl Sherman is a freelance medical writer in New York City.


  1. Wolf AM, Wender RC, Etzioni RB, et al. American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J Clin. 2010;60:70-98.
  2. American Cancer Society. Information for health-care professionals.

All electronic documents accessed October 3, 2011.