I think that there are better documents to guide doctors in detection of prostate cancer than the American Cancer Society. I really don't understand all the uproar over the recent ACS update - they haven't called for mass screening since 1997.

The NCCN Guidelines provide a detailed, nuanced set of flowcharts to guide the physician. (You can download the entire document from NCCN but you must register.)

The NCCN prostate cancer panel is comprised of leading doctors from leading cancer hospitals including MD Anderson, Memorial Sloan Kettering, and Johns Hopkins, to name a few. Some of the names are familiar: D'Amico, Kawachi, Lange, Walsh, among others.

The "Prostate Cancer Early Detection" guidelines ( http://www.nccn.org/professionals/physician_gls/PDF/prostate_detection.pdf ) call for, at age 40, a discussion of the risks and benefits of PSA testing, and the offer of a baseline DRE and PSA.

If, at age 40, PSA is 1.0 or greater, OR the man is African American or has a family history, the recommendation is for annual DRE/PSA testing to follow (there are more detailed guidelines, too much to go into here, about what to do at various PSA levels over 1.0)

If, at age 40, PSA is less than 1.0, AND the man is other than African American and has no family history of prostate cancer, the recommendation is that he return at age 45 for another DRE and PSA. If the result is the same, he can come back at 50, when the recommendation is regular testing.

If the DRE is positive, a biopsy is recommended, regardless of PSA level.

The decision tree is much more detailed than I have laid out here - including what to do in regards to PSA velocity - but that is the gist of it. It is very similar to what I've seen of the AUA guidelines. I think the NCCN is meeting this month, and the document notes that the guidelines are always a work in progress, so some parts may change. What I've accessed and referenced here is version 2.2010. If you are interested in the issue of prostate screening, I would encourage you to look at the NCCN guidelines, and don't skip the talking points at the end, where the panel discusses some of the subtleties and nuances inherent in the issue.

I like that first step: "PSA offered at 40". Then the decision tree expands.
(My PCP would have waited until I was 57.) Yikes.