How does age and family history influence the decision to perform PSA testing in men?

Age and family history are important factors influencing the decision to perform prostate-specific antigen (PSA) testing in men.

Older age increases the risk of prostate cancer, and thus PSA testing is more commonly considered in men as they age, particularly when life expectancy and comorbidities are taken into account to balance benefits and harms of testing and subsequent investigations.

A strong family history of prostate cancer is a significant risk factor that raises suspicion and may prompt earlier or more frequent PSA testing. For example, men with a strong family history may be offered prostate biopsy if PSA levels are raised, even if other indicators such as MRI findings are not strongly suggestive of cancer.

Decisions about PSA testing and further investigations should be individualized, considering age, family history, PSA kinetics (density and velocity), and overall health status.

This approach aims to identify clinically significant prostate cancer early while avoiding unnecessary biopsies and overdiagnosis in men at lower risk.

References: ¹