A single prostate-specific antigen (PSA) test in midlife may help identify men at very low risk of prostate cancer for up to 20 years, according to research published in JAMA Network Open. The findings suggest that men with low baseline PSA levels could safely undergo less frequent screening, potentially reducing unnecessary biopsies and overdiagnosis.
The study, led by researchers at Charité Universitätsmedizin Berlin, analysed data from 2,651 men aged 45 to 70 participating in Germany’s Study of Health in Pomerania (SHIP). Participants were followed for up to two decades to assess long-term prostate cancer incidence.
More than half of the men (55.9%) had baseline PSA levels below 1.00 ng/mL. In this group, prostate cancer developed in just 0.1% at five years, 0.6% at ten years, and 3.3% at twenty years, indicating a very low long-term risk. By contrast, men with intermediate PSA levels (1.00–3.00 ng/mL) faced higher cumulative risks of 1.4%, 5.0%, and 11.8% at five, ten, and twenty years, respectively. The highest-risk group, those with PSA levels above 3.00 ng/mL, showed substantially greater incidence, reaching nearly 35% at twenty years.
Statistical analysis found that only three traditional factors were independently associated with prostate cancer risk: age, PSA level, and PSA density. Although PSA density was informative, it requires imaging and may be too costly for routine screening.
The researchers argue that these findings support a shift from a “rule-in” approach, where elevated PSA triggers biopsy, to a “rule-out” strategy. Men aged 50 to 59 with PSA levels below 1.00 ng/mL, in particular, may be able to delay or avoid further screening. The study aligns with existing European guidelines advising against continued screening in older men with very low PSA levels, while highlighting the need for further research into personalised, risk-adapted screening strategies.
