What are the current guidelines for prostate cancer screening in asymptomatic men?

Current UK guidelines do not recommend routine prostate cancer screening for asymptomatic men ²,³. Instead, prostate-specific antigen (PSA) testing and digital rectal examination (DRE) are considered in specific circumstances ²,³.

For men presenting with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction secondary to benign prostate enlargement (BPE), or if their prostate feels abnormal on DRE, or if they are concerned about prostate cancer, they should be offered information, advice, and time to decide if they wish to have PSA testing ². A physical examination, including an abdominal, external genitalia, and DRE, is also offered at initial assessment for men with LUTS ². If a DRE indicates a malignant prostate or if PSA levels are above the age-specific reference range, a suspected cancer pathway referral (for an appointment within 2 weeks) for prostate cancer should be made ³.

In contrast to the UK approach, recent international literature indicates that some countries have developed or are proposing organized prostate cancer screening programs (Ficarra et al., 2024; John et al., 2024). For example, the Italian Society of Urology has put forward a proposal for an organized screening program (Ficarra et al., 2024), and South Africa has published specific guidelines for prostate cancer screening (John et al., 2024).