Middle-aged men should undergo regular screening for prostate cancer, the American Cancer Society said on Thursday in a major change to U.S. health guidance.
The updated guidelines change policy for the first time since 2010, replacing shared decision-making discussions with a direct recommendation for routine testing. The organization now advises that men at average risk take a prostate-specific antigen blood test every two years from ages 50 to 69.
Risk-Based Screening Schedules for Black Men and Families
Under the revised framework, screening schedules vary according to personal risk factors and family history. Black men should begin annual PSA testing at age 45 and continue through age 69. Black men in general and men with a family history have a higher risk of prostate cancer, and their prostate cancers are at higher risk for progressing more rapidly than non-Black men.
“If you delay screening, we know that you lose the window of opportunity to diagnose the patients with curable disease.” @DanaFarber’s @neerajaiims in @CNN on @AmericanCancer’s new prostate cancer screening guidelines. ➡️https://t.co/ywev8UFR3s
Among Black males residing in Washington, D.C., the prostate cancer incidence rate stands at 161 per 100,000, contrasted with 99 per 100,000 among white males in the city. The importance of these modifications in the nation’s capital was highlighted by Dr. Arnold Baskies, a surgical oncologist and former chairman of the American Cancer Society’s National Board of Directors.
Annual screenings at age 45 are also advised for males who have either one family member diagnosed prior to age 65 or a minimum of two immediate relatives—such as a father, brother, or son—with prostate cancer, while individuals with just a single immediate relative diagnosed at age 65 or later should be tested biennially starting at 45.
Emphasizing that individual risk variations make a uniform approach unsuited for everyone, Ash Tewari—who heads the urology department at Mount Sinai’s Icahn School of Medicine in New York—explained that the revised guidance removes uncertainty by explicitly instructing men to get screened.
Tewari and Mount Sinai have also engaged in outreach efforts, such as sending out the Mount Sinai Robert F. Smith Mobile Prostate Cancer Screening Unit in New York City in 2022 and deploying another bus to the Atlanta Falcons-Chicago Bears game at Mercedes-Benz Stadium in Atlanta.
Dr. Shanthi Sivendran is the interim chief patient officer for the American Cancer Society.
New guidelines: @AmericanCancer now recommends men between the ages of 50 to 69 get a prostate cancer blood test every two years. This is the first step toward a more regular screening approach. 🔗 Learn more about why the guidelines have changed: https://t.co/5mHfRYADR2 pic.twitter.com/CQM5qiP3Du
“Think of prostate cancer screening as an early warning system for your health,” said Dr. Shanthi Sivendran, interim chief patient officer for the American Cancer Society.
Stronger Evidence Outweighs Previous Harms
The revised recommendations stem from mounting clinical data collected over the past decade.
JUST IN: @AmericanCancer (ACS) updates their guidance about routine PSA screening for #prostatecancer, moving off "shared decision-making". This is a major shift since the last ACS recommendations in 2010: 1) High risk (Black men; first-degree relative dx <65 or multiple at… pic.twitter.com/Wa3pxJa6kY
“Since the ACS last issued a prostate cancer screening guideline, accumulating evidence has confirmed that screening reduces prostate cancer mortality and distant-stage disease,” wrote the expert advisors in a report published in CA: A Cancer Journal for Clinicians.
“PSA testing remains the cornerstone of detecting prostate cancer early, and we now have stronger evidence of its benefits,” said Dr. Robert Smith, senior vice president of early cancer detection science and director of the Center for Early Cancer Detection at the American Cancer Society and senior author of the report.
Dr. William Dahut, the society’s chief scientific officer, said that PSA screening can actually decrease one’s chance of dying from prostate cancer.
Earlier guidelines cautioned against widespread testing due to concerns over false positives and the overtreatment of slow-growing tumors. According to Dr. Andrew Wolf, a physician at the University of Virginia and lead author of the guidelines, advances in secondary testing now allow clinicians to better distinguish aggressive cancers from harmless ones.
The @AmericanCancer has released its updated prostate cancer screening guideline, recommending PSA-based screening for men ages 50 and up (or 45 and up for those at higher risk). At Siteman Cancer Center, we applaud and support this increased vigilance, and we encourage men to…
The interdisciplinary volunteer Guideline Development Group was chaired by Wolf and included clinicians, epidemiologists, biostatisticians, and patient representatives. Other members of the team included Walter, Charnita Zeigler-Johnson, Timothy R. Church, Christopher K. Jones, Artie L. Shelton, Elena B. Elkin, Carmen E. Guerra, Rebecca B. Perkins, Ya-Chen Tina Shih, Steven J. Skates, Roman Gulati, Hormuzd A. Katki, Tyler B. Kratzer, Deana Manassaram-Baptiste, William L. Dahut and Smith.
“But what’s happened now is that it’s quite clear that the benefits of screening, in terms of reducing the risk of dying from prostate cancer and the risks of being diagnosed with metastatic disease, late-stage disease, are significantly lowered by regular screenings of PSA blood tests,” Wolf said.
Clinical Protocols for Elevated Test Results
When an initial blood draw reveals elevated antigen levels, clinicians are advised to follow specific diagnostic pathways before performing invasive biopsies. Individuals aged 45 to 74 who exhibit high PSA levels ought to receive a follow-up PSA test anywhere from a fortnight to three months following their initial screening, per the official protocols.
Persistent elevations should be evaluated using magnetic resonance imaging or urine and blood biomarkers to determine if a biopsy is necessary.
For patients diagnosed with low-risk tumors, the guidelines recommend active surveillance as the primary management strategy.
Routine screening is not recommended for men aged 75 or older, or for individuals with a life expectancy of less than 10 years due to other health conditions. Men aged 70 to 74 are advised to consult their physicians to decide whether continued screening remains appropriate, as the balance of benefits and harms is less certain in that age group.
Earlier coverage: American Cancer Society Updates Prostate Cancer Screening Rules