The American Cancer Society has released new prostate cancer screening guidelines. These guidelines actively recommend screening for middle-aged men, a shift from previous advice. Prostate cancer screening advice has been somewhat ambiguous for years, with conflicting trial results influencing recommendations. When the ACS last updated its guidance in 2010, it stopped short of recommending PSA testing, instead encouraging men to decide after discussing the pros and cons with their doctor.
Screening Starts at 50 for Average-Risk Men
For men at average risk, the ACS now advises PSA testing every two years between ages 50 and 69. This is a “B” recommendation with moderate evidence certainty. The advantages are anticipated to outweigh the downsides for most men in this category. The U.S. Preventive Services Task Force initially suggested against PSA screening in 2012 but changed course in 2018 to agree with the ACS, recommending individualized choices for men aged 55 to 69. Now, with longer-term trial results, the ACS strongly advises screening for middle-aged men.
The PSA test is a blood test with almost no risk. However, a high PSA level can lead to false alarms, biopsies, and treatment for slow-growing cancers that may never cause problems. Despite these risks, many men are willing to undergo screening due to rising prostate cancer rates in the U.S.
Higher-Risk Groups Face Different Recommendations
Black men have a greater chance of prostate cancer. They should begin annual PSA screening at age 45 through 69. Men with a significant family history should also start annual screening at 45. A significant family history is defined as a first-degree relative diagnosed before 65 or several first-degree relatives diagnosed at any age. Men with just one first-degree relative diagnosed at 65 or later should start screening every two years at 45. These specific recommendations show how risk levels vary across different groups.
Repeat Tests and Additional Measures
A PSA of 3.0 ng/mL or higher for men 69 and younger, or 6.5 ng/mL or higher for those 70 to 74, should prompt a repeat test. This should be done two weeks to three months later, before further evaluation. PSA levels can fluctuate due to non-cancerous factors, so a single high reading isn’t definitive.
If a repeat PSA confirms an raised result, the guideline recommends offering an MRI and/or a validated biomarker blood test before deciding on a biopsy. This extra step is designed to cut down on overdiagnosis, reducing unnecessary procedures and treatments for slow-growing cancers that may never cause harm.
Active Surveillance for Low-Risk Diagnoses
A low-risk diagnosis doesn’t mean immediate treatment. The ACS recommends that men diagnosed with prostate cancer are first offered active surveillance. This is ongoing monitoring through repeat PSA tests, imaging, and biopsies. Prostate cancer tends to spread slowly, making immediate treatment often unnecessary. This approach has gained popularity, with studies showing more men opting against surgery.
When to Stop Screening
The new guidelines draw clearer boundaries around when screening should end. For ages 70 to 74, the decision is individualized, based on personal health and preferences. A manual rectal exam is no longer recommended as a primary screening tool; PSA screening has taken its place.
Here are the 6 most important takeaways from the new guidelines: average-risk men should get screened every two years starting at 50; higher-risk groups, like Black men and those with a strong family history, face different screening timelines; repeat tests are recommended for raised PSA levels; imaging and biomarker tests can help avoid unnecessary biopsies; active surveillance is preferred for low-risk diagnoses; and screening should stop at age 75 or for those with a life expectancy under 10 years.