Table 1:

Summary of clinical guidelines for PCa screening.

Clinical guidelines, year (reference)	General recommendation	Additional information	Other recommended biomarkers
EAU–ESTRO–SIOG, 2017 [30]	Offer an individualized risk-benefit weighing to well-informed men with a life expectancy of at least 10–15 years.	Offer PSA assessment to men older than 50, older than 45 with family history of PCa, Afro-American older than 45, men with PSA >1 µg/L at 40 years or >2 µg/L at 60 years.	Free PSA enables PCa risk stratification in men with a PSA of 4–10 µg/L and a previous negative biopsy. New risk stratification assays that include PHI and 4Kscore to spare men with a PSA of 2–10 µg/L unnecessary biopsies.
AUA, 2018 [31]	For 55–69 year-old men, weigh the risks and benefits associated with screening and active therapies. Screening is not recommended in men younger than 54 years with an intermediate risk of PCa, in men older than 70, or in men with a life expectancy below 10–15 years.	Decision should be made on a case-by-case basis for men younger than 55 years with a high risk of developing PCa, i. e., Afro-American and men with a family history of metastatic cancer.	PSA derivatives (PSA density, specific ranges according to the age of the patient), PSA kinetics (velocity and doubling time), percentage of free PSA, proPSA and PCA3 should be considered secondary tests potentially useful to determine the need to perform or repeat a prostate biopsy.
USPSTF, 2018 [32]	The decision should individualized for 55–69 year-old men. The potential risks and benefits of screening should be previously discussed with the patient. Screening should not be performed in men older than 70 years.	Screening should not be performed in individuals younger than 55 years with an intermediate risk of PCa nor even to obtain baseline PSA. Men with a family history of PCa and Afro-Americans are at a high risk of developing PCa.	Not recommended
NCCN, 2019 [33]	The decision to participate in an early PCa screening should be made after an adequate weighing of its associated risks and benefits. There is no general agreement as to the age range at which PCa screening should be performed.	Most experts agree that screening should start at 45 years. Screening will be repeated at 2–4-year intervals in men 45–75 years of age if PSA is <1 µg/L, or at 1–2-year intervals if PSA is >1 µg/L.	A percentage of free PSA <10%, PHI >35 or 4Kscore (which shows the probability of developing a high-risk PCa) are potential indicators of the need to perform a biopsy. A PCA3 >35 is potentially informative after a previous negative biopsy.
NICE, 2019 [34]	The decision to obtain a prostate biopsy should not be made only on the basis of PSA concentration. A MRI scan should be the first-choice test for individuals with clinical symptoms of localized PCa. Adequately-informed patients have the right to participate in decision-making.	Family history, and PSA density and velocity should be assessed when considering a biopsy in individuals with a low risk of developing PCa based on MRI results, and high PSA concentrations.	PCA3 and PHI are not recommended for individuals with clinical symptoms of PCa whose biopsy was negative.

PCa, prostate cancer; PCA3, Prostate Cancer 3 gene; PHI, Prostate Health Index; PSA, Prostate-specific antigen; AUA, American Urological Association; EAU, European Association of Urology; ESRO, European Society for Radiotherapy and Oncology; NCCN, National Comprehensive Cancer Network; NICE, National Institute for Health and Care Excellence; SIOG, International Society of Geriatric Oncology; USPSTF, US Preventive Services Task Force.