Indications for ordering:
(1) evaluating treatment efficacy during therapy for prostate cancer
(2) assessing prostate cancer progression after therapy
(3) monitoring for prostate cancer recurrence 2-4 times per year (done every 3 months for the first year after curative treatment, every 4 months for the second year after curative treatment, and every 6 months for each subsequent year after curative treatment)
(4) diagnostic workup and staging in men with signs and symptoms associated with prostate cancer
(5) evaluation of men with cancer of unknown primary site
(6) establishing a baseline value before beginning therapy for benign prostatic hypertrophy (BPH) with a 5 alpha-reductase inhibitor such as finasteride
(7) annual screening of asymptomatic men from 50-75 years of age, accompanied by a digital rectal examination
(8) annual screening of asymptomatic men from 40-49 years of age with a family history of prostate cancer, accompanied by a digital rectal examination
(9) annual screening of asymptomatic men from 40-49 years of age who are Afro-American, accompanied by a digital rectal examination
(10) as a staging modality to replace bone scan in selected cases of prostate cancer
where:
• Items 7-10 are appropriate but debated.
• Screening patients with evidence of benign prostatic hypertrophy (whether not treated with finasteride or after finasteride started) is not explicitly stated. In the implementation I will assume that they will be handled similar to asymptomatic men.
Inappropriate use of testing:
(1) screening asymptomatic men older than 75 years of age
(2) screening asymptomatic men with less than 10 years of life expectancy
(3) screening asymptomatic men with no risk factors who are younger than 50 years of age
(4) screening asymptomatic men with risk factors who are younger than 40 years of age
