6 Big Takeaways From The American Cancer Society's New Prostate Cancer Screening Guidelines
Prostate cancer screening advice has been somewhat ambiguous for years.
When the American Cancer Society (ACS) last updated its guidance in 2010, two large trials had reached conflicting conclusions about whether prostate-specific antigen (PSA) testing, the primary tool used to screen for prostate cancer before symptoms appear, saved lives. The group stopped short of recommending PSA testing, and instead encouraged men to make the decision themselves after talking through the pros and cons of a PSA test with their doctor.
The U.S. Preventive Services Task Force took this one step further in 2012, recommending against PSA screening. In 2018, they shifted to align with the ACS, recommending an individualized decision for men ages 55 to 69.
Now, with longer-term trial data in hand, the ACS has released new prostate cancer guidelines that actively recommend screening for middle-aged men. Here are the 6 most important takeaways from the new guidelines, and what the changes means for you and the men you care about.
Average-risk men should get screened every two years starting at 50
For men at average risk, the ACS now recommends PSA-based screening every two years from ages 50 through 69. This is classified as a "B" recommendation with moderate certainty of evidence, meaning the benefits are expected to outweigh the harms for most men in this group.
What harms, you may wonder? The PSA test is a blood test with almost no-risk, but a high PSA level can lead to false alarms, biopsies that can cause pain or infection, and treatment for slow-growing cancers that never would have caused problems.
However, most men are willing to take this chance, especially with the context of increasing rates of prostate cancer in the U.S. Plus, as you will see, not all prostate cancers require significant intervention.
Screening recommendations differ for higher-risk groups
Risk isn't the same for everyone, and the guideline reflects that.
Black men face a higher risk of prostate cancer, and should start annual PSA screening at age 45 through 69.
Men with a strong family history—meaning a first-degree relative diagnosed before age 65, or multiple first-degree relatives diagnosed at any age—should also begin annual screening at 45. Men with a single first-degree relative diagnosed at 65 or older should start screening every two years at age 45.
There's a specific PSA number that should trigger a repeat test
PSA levels can fluctuate for reasons that have nothing to do with cancer, so one high reading isn't the final word.
Under the new guideline, 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 two weeks to three months later, before moving on to further evaluation.
Imaging & biomarker tests can help avoid unnecessary biopsies
If a repeat PSA confirms an elevated 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, catching and treating slow-growing cancers that may never have caused harm in the first place.
A low-risk diagnosis doesn't mean jumping straight to treatment
Being diagnosed with low-risk prostate cancer doesn't automatically mean surgery or radiation. While prostate cancer is on the rise, the mortality rate is fairly low because, compared to other cancers, prostate cancer tends to spread slowly.
That's why the ACS recommends that men diagnosed with prostate cancer are first offered active surveillance, which is ongoing monitoring through repeat PSA tests, imaging, and biopsies, rather than immediate treatment. This option has become increasingly common, as studies have shown an increase in men choosing not to have surgery to remove prostate tumors1.
There's new guidance on when to stop screening
The new guidelines also draw clearer boundaries around when screening should wind down. PSA testing is no longer recommended once men reach age 75, or for men of any age with a life expectancy under 10 years. For ages 70 to 74, the decision is individualized, based on personal health and preferences.
One more change: a manual rectal exam is no longer recommended as a primary screening tool. PSA screening has taken the top spot.
The takeaway
Guidelines are a starting point, not a one-size-fits-all script. If any of this raises questions about your own risk, or that of someone you care about, it's worth bringing up at your next doctor's visit. A conversation about risk factors and the right cancer screening timeline can make all the difference in catching prostate cancer early, when it's most treatable.