The American Cancer Society (ACS) now recommends that men aged 50 to 69 undergo routine prostate cancer screening every two years to reduce the risk of death from the disease.
The updated guidelines, published Thursday in CA: A Cancer Journal for Clinicians, represent a significant shift from the organization’s previous stance, which emphasized individual decision-making between patients and their doctors. Under the new protocol, men at higher risk—specifically Black men and those with a strong family history of the disease—are advised to begin annual screening at age 45.
The ACS update follows new evidence suggesting that regular testing with the prostate-specific antigen (PSA) blood test can actually decrease one’s chance of dying from prostate cancer.
Testing intervals based on PSA levels and age
The guidelines establish specific intervals based on a patient’s PSA levels. Men with a PSA of 3.0 or higher are now advised to undergo annual testing, while men with a PSA of 2.5 or lower should be screened every two years.
For men aged 70 to 74, the ACS suggests that the decision to continue screening should be made in consultation with a physician, weighing personal health and life expectancy. Screening is not recommended for men 75 or older, or those not expected to live another 10 years.
Risks of overdiagnosis versus benefits of detection
The medical community has long debated the utility of universal screening due to the risk of overdiagnosis and overtreatment. Because many prostate cancers are slow-growing and may never cause issues in men who have them, early detection can lead to unnecessary biopsies and treatments that carry risks of urinary incontinence, erectile dysfunction, and bowel problems.
As rates of advanced prostate cancer continue to rise, the American Cancer Society is recommending that most men ages 50 to 69 get screened every other year. https://t.co/nuEbAOD0S2
Despite these concerns, supporters of the new guidelines point to long-term data indicating that screening remains a vital tool.
“We thought it was really important to update our prostate cancer guidelines, because now there is true evidence that prostate cancer screening with the PSA test, a blood test, can actually decrease one’s chance of dying from prostate cancer,” Dr. William Dahut, chief scientific officer at the ACS, said in an interview released by the organization.
Divergent medical guidelines
The ACS update disagrees with other major health organizations, as screening recommendations vary across the U.S. The U.S. Preventive Services Task Force (USPSTF) maintains its position that for men between 55 and 69, the choice to pursue periodic PSA-based prostate cancer screening should be a personal one. Meanwhile, the American Academy of Family Physicians does not recommend PSA screening for prostate cancer at all.
Frequently asked questions
Why is the shift in guidelines considered a reversal?
Previous recommendations emphasized “informed decision-making” that urged men to discuss prostate cancer screening with a health care provider. The new guidelines move toward a more standardized, proactive approach for specific age groups.
How does family history influence the screening age?
Individuals who have a father or brother who received a diagnosis before turning 65, or who have multiple relatives with the disease regardless of age, fall into a high-risk category and are advised to start annual testing at 45.
What happens if a PSA test result is elevated?
Patients who receive high PSA readings may consult their physician regarding the potential utility of an MRI scan.
The long-term impact of these guidelines on clinical practice is uncertain; official changes to prostate cancer screening guidelines take years to be adopted, though many doctors follow ACS guidelines.
TODAY the American Cancer Society made important changes to their prostate cancer screening guidelines: Men 50 to 69 should get a PSA test every two years; Black men and men with a family history of prostate cancer should get one every year starting at 45; and starting at age 70,… https://t.co/ej7Ge46sjx
“So please, talk to your primary care doctor about our updated guidelines and seriously consider prostate cancer screening if you're within the age range,” said Neeraj Agarwal, a medical oncologist who serves as co-director of the Prostate Cancer Program at the Dana-Farber Cancer Institute/Harvard Cancer Center.
More on William Dahut
The American Cancer Society recommended routine PSA screening for prostate cancer, changing guidelines in place since 2010. https://t.co/9qPSSg08Yr