American Cancer Society Overhauls Prostate Cancer Screening Advice, Urges Regular PSA Tests for Men From 50

ATLANTA — The American Cancer Society has made a major change to its prostate cancer screening advice. It now recommends that most middle-aged men get regular blood tests to catch the disease before it spreads.

The updated guideline, released Thursday, is the group's first full revision of its prostate screening recommendations since 2010. It replaces earlier advice that left the decision largely to conversations between men and their doctors.

What the New Guideline Says

Under the updated recommendations:

Men at average risk ages 50 to 69 should get a prostate-specific antigen, or PSA, blood test every two years. Black men and men with a strong family history of prostate cancer should start annual PSA screening at age 45. Men ages 70 to 74 should make an individualized decision with their doctor about whether to keep screening. The society no longer recommends screening at 75. Particularly healthy men ages 75 to 79 may choose to continue, but the group discourages screening once men turn 80.

The previous guideline did not directly recommend regular screening. It instead advised most men to make a shared decision with their health care provider about whether to be tested.

Why the Change

The cancer society said there is now stronger evidence that PSA screening significantly reduces deaths from prostate cancer and the number of men diagnosed at an advanced stage.

"PSA testing remains the cornerstone of detecting prostate cancer early, and we now have stronger evidence of its benefits," said Dr. Robert Smith, the society's senior vice president for early cancer detection science and senior author of the report.

The group also cited advances in reducing the harms of screening. In the past, many men with slow-growing cancers that might never have threatened their lives received unnecessary biopsies and treatments, with side effects such as incontinence and erectile dysfunction.

Doctors increasingly use MRI scans to decide who needs a biopsy. Many men with low-risk cancers are now placed on "active surveillance," with regular monitoring instead of immediate surgery or radiation.

Focus on Disparities

The guideline puts particular emphasis on Black men, who are more likely to develop prostate cancer and die from it.

"By making a direct recommendation for men to engage in screening and advocating for earlier and more frequent screening for Black men, our aim is also to help reduce prostate cancer disparities and ease the disease burden," said Dr. William Dahut, the society's chief scientific officer and a contributing author.

The guideline's authors said they hope more screening will reduce the number of Black patients diagnosed after their cancer has spread.

A Common Cancer

Prostate cancer is one of the most common cancers in men. The American Cancer Society estimates that about 1 in 8 men will be diagnosed with it during their lifetime.

When found early, before it spreads beyond the prostate, the disease is usually highly treatable. Once it spreads to the bones or other organs, it is much harder to treat.

Doctor Conversations Still Matter

The guideline still stresses that doctors and patients should discuss the benefits and risks of screening. PSA levels can be raised by conditions other than cancer, such as an enlarged prostate or infection, so an abnormal result does not necessarily mean a man has cancer.

The cancer society calls its recommendations a "living guideline." It says it will monitor new evidence and update the advice as screening and treatment improve.

The American Cancer Society's guidance is separate from that of the U.S. Preventive Services Task Force, an independent federal panel that influences insurance coverage. The task force's older guidance advised men 55 to 69 to make an individual decision about screening and is under review.

Men with questions about their risk or about screening should talk with their doctor.