What are the recommended screening guidelines for prostate cancer in men over 50?

Recommended screening guidelines for prostate cancer in men over the age of 50 in the UK do not endorse routine population-wide screening but recommend a targeted approach based on informed decision-making and clinical indications. Men aged 50 and over who present with lower urinary tract symptoms, erectile dysfunction, or visible haematuria should be offered a prostate-specific antigen (PSA) test and digital rectal examination (DRE) to assess for prostate cancer. Referral via a suspected cancer pathway (urgent referral within 2 weeks) is advised if PSA levels are above the age-specific reference range or if the prostate feels malignant on DRE ¹,³.

Screening is not routinely recommended for asymptomatic men; instead, men should be provided with information about the benefits and risks of PSA testing to make an informed choice. Shared decision-making is emphasized, with healthcare professionals offering tailored information and decision aids to men considering PSA testing ¹.

For men undergoing active surveillance after diagnosis, PSA testing is recommended every 3 to 6 months initially, with DRE and multiparametric MRI used periodically to monitor disease progression ¹.

Recent literature highlights that Western guidelines, including those from the UK, are based on studies from the 2000s and may not be directly applicable to all populations, such as Asian men, suggesting that screening policies might need adaptation based on ethnicity and evolving evidence (Ko and Kim, 2022). However, the UK guidelines remain the standard reference for clinical practice in the UK [1, (Ko and Kim, 2022)].