Supplementary Table 1.

Prostate cancer screening guidelines by other organizations

Association (year)	Age (years)	Screening recommended (yes/no)	Additional details on recommendations	Frequency
United States Preventative Services Task Force (Recommendation Statement)a (2017)7	55–69	Yesb	– Clinicians should inform men about the potential benefits and harms of PSA-based screening for prostate cancer – The decision about whether to be screened for prostate cancer should be an individual one – Current evidence does not support separate, specific recommendations on PSA-based screening for high-risk populationsc	NR
	≥70	No	– USPSTF recommends against PSA-based screening for prostate cancer in men age 70 years and older – Evidence from randomized clinical trials is consistent with no mortality benefit of PSA-based screening for prostate cancer in men age 70 years and older	NR
European Association of Urology (2016)5	>50		– Do not subject men to PSA testing without counselling them on the potential risks and benefits – Offer an individualized, risk-adapted strategy for early detection to a well-informed man with a good performance status and a life-expectancy of at least 10–15 years – Decide on the age at which early diagnosis of prostate cancer should be stopped based on life expectancy and performance status	– Offer risk-adapted followup based on initial PSA level – Followup intervals of 2 years for those initially at riskd – Postpone followup to 8 years in those not at risk
	>45 if at elevated riskc,d	Yesb
	<15 years life expectancy	No	– Randomized data suggest that men who have a life expectancy of <15 years are unlikely to benefit	NA
National Comprehensive Cancer Network (2016)4	45–75	Yesb	– Baseline evaluation should include history and physical exam, including family history, medications, history of prostate disease and screeninge, racef and family history of BRCA1/2 mutations – Risk assessment should include initiating discussion of risks and benefits of prostate screening, baseline PSAg and consideration of baseline DREg	– If PSA <1 ng/mL and DRE normal (if done), repeat testing at 2–4-year intervalsh – If PSA 1–3 ng/mLi and DRE normal (if done), repeat testing at 1–2-year intervals – If PSA >3 ng/mLi or very suspicious DRE, consider indications for biopsy – If PSA <3 ng/mL and DRE normal (if done), and no other indications for biopsy, repeat testing at 1–4-year intervals
	>75	Yesj
Canadian Task Force on Preventative Health (2014)8	<55	No	Based on: – Low incidence of prostate cancer and prostate cancer mortality – Lack of evidence for benefit of screening in this age group – Evidence of harms	NR
	55–69	No	This recommendation places: – Relatively low value on a small and uncertain potential reduction – In prostate cancer mortality – Relatively higher value on the risk of a false-positive result, unnecessary biopsies, over-diagnosis of prostate cancer, and harms associated with unnecessary treatment Therefore: – Risks and benefits of PSA screening and its potential consequences should be discussed with each patient in the context of his preferences – Men who place a high value on a small potential reduction in mortality and are less concerned with undesirable consequences may choose to be screened	NR
	≥70	No	This recommendation reflects: – Lower life expectancy – Lack of evidence for benefit of screening in this age group – Evidence of harms	NR
American Urological Association (2013)3	<40	No	– Low prevalence of clinically detectable prostate cancer – No evidence demonstrating benefit of screening – Likely the same harms of screening as in other age groups	NR
	40–54	Yesb	– The Panel does not recommend routine screening in average-risk men in this age group – Decisions regarding prostate cancer screening should be individualized for men younger than age 55 years at higher riskc	– For those who choose screening, a routine screening interval of 2 years or more may be preferred over annual screening to preserve the majority of the benefits and reduce over-diagnosis and false-positives
	55–69	Yesb	– Shared decision-making, weighing benefits and harms, is strongly recommended for men considering PSA screening, then proceeding based on individual values and preferences – The greatest benefit of screening appears to be in men ages 55–69 years
	≥70	No	– The Panel does not recommend routine PSA screening in men age ≥70 years or any man with less than a 10–15 year life expectancy – Some men age ≥70 years who are in excellent health may benefit from prostate cancer screening	NR
American College of Physicians (2013)6	<50	No	– ACP recommends not screening for prostate cancer via PSA in average-risk men in this age group	– No clear evidence is currently available to guide decisions about the periodicity or frequency of the evaluation of risk for prostate cancer or discussion about the benefits and harms
	50–69	Yesb	ACP recommends that clinicians: – Inform men about the limited potential benefits and substantial harms of screening – Base the decision to screen on the risk for prostate cancer, a discussion of the benefits and harms of screening, the patient’s general health and life expectancy, and patient preferences – Do not screen using the PSA test in patients who do not express a clear preference for screening
	≥70	No	– ACP recommends not screening for prostate cancer via PSA in men over the age of 69 years, or those with a life expectancy of less than 10–15 years

^aDraft recommendation statement was available for public comment until May 8, 2017; final statement in development;

^bon case-by-case basis after discussion of risks and benefits;

^cAfrican-American men and/or family history of prostate cancer;

^dmen with prior PSA assessment and a PSA level of >1 ng/mL at 40 years of age or >2 ng/mL at 60 years of age;

^eincluding prior PSA and/or isoforms, exams, and biopsies;

^FAfrican-American men have a higher incidence of prostate cancer, increased prostate cancer mortality, and earlier age of diagnosis compared to Caucasian-American men; however, the effects of earlier or more intensive screening on cancer outcomes and on screening-related harms in African-American men remain unclear. Although they may require a higher level of vigilance and different considerations when analyzing the results of screening tests, current data do not support separate screening recommendations for African-American men;

^gthe best evidence supports the use of serum PSA for the early detection of prostate cancer. DRE should not be used as a stand-alone test, but should be performed in those with an elevated serum PSA. DRE may be considered as a baseline test in all patients as it may identify high-grade cancers associated with “normal” serum PSA values. Consider referral for biopsy if DRE is very suspicious. Medications such as 5α-reductase inhibitors (finasteride and dutasteride) are known to decrease PSA by approximately 50%, and PSA values in these men should be corrected accordingly;

^hmen age ≥60 years with serum PSA <1.0 ng/mL have a very low risk of metastases or death due to prostate cancer and may not benefit from further testing. A PSA cut point of 3.0 ng/mL at age 75 years also low risk of poor outcome;

ⁱthe reported median PSA values for men aged 40–49 years range from 0.5–0.7 ng/mL, and the 75th percentile values range from 0.7–0.9 ng/mL. Therefore, the PSA value of 1.0 ng/mL selects for the upper range of PSA values. Men who have a PSA above the median for their age group are at a higher risk for prostate cancer and for the aggressive form of the disease. The higher above the median, the greater the risk; jtesting above the age of 75 years should be done with caution and only in very healthy men with little or no comorbidity, as a large proportion may harbour cancer that would be unlikely to affect their life expectancy, and screening in this population would substantially increase rates of over-detection; however, a clinically significant number of men in this age group may present with high-risk cancers that pose a significant risk if left undetected until signs or symptoms develop. One could consider increasing the PSA threshold for biopsy in this group (i.e., >4 ng/mL). Very few men above the age of 75 years benefit from PSA testing.

ACP: American College of Physicians; BRCA1/2: breast cancer type 1/2 susceptibility gene; DRE: digital rectal exam; NA: not applicable; NR: not reported; PSA: prostate-specific antigen.