Cancer Society Calls for Regular Prostate Screening

The American Cancer Society has changed its prostate cancer screening guidance, moving from recommending discussions with doctors to advising routine prostate-specific antigen (PSA) blood tests for men at average risk between 50 and 69. The group recommends annual tests beginning at 45 for Black men and men whose close relatives have had the disease.

The updated advice reflects evidence that PSA screening can reduce deaths and advanced-stage diagnoses. Prostate cancer ranks among the cancers most frequently diagnosed in U.S. men, and mortality from it is surpassed only by lung cancer in this group. Black men are twice as likely as white men to die from the disease.

For men ages 45 to 69, a PSA reading of 3 nanograms per milliliter or higher is considered elevated. The guidelines call for repeating an elevated test before moving to further assessment, which may include an MRI or biomarker tests to help determine whether a biopsy is needed. They also recommend active surveillance as the initial approach for men whose cancers have a low risk of growing or spreading.

Screening decisions should be individualized from age 70, as the balance of benefits and harms becomes less certain. The guidance advises against screening most men 75 and older, and says screening should stop after 80 or when a man is not expected to live another 10 years.

The U.S. Preventive Services Task Force continues to recommend individualized decisions rather than routine population-wide screening. Its guidance is being updated. The Cancer Society’s recommendations also stress limiting unnecessary procedures and treatment, which have been concerns with PSA testing.