American Cancer Society Now Recommends Regular PSA Prostate Screening

The American Cancer Society on Thursday issued new guidelines urging most men to get regular prostate-specific antigen (PSA) blood tests for prostate cancer, a shift toward more routine screening that could affect millions of Americans.^[1]

Under the updated recommendations, released Thursday, average-risk men should have a PSA blood test every two years between ages 50 and 69, while men at higher risk are advised to start screening earlier and more often.^[1] High-risk groups, including Black men and those with a strong family history of prostate cancer, are now advised to begin annual PSA testing at age 45, with "strong family history" defined as having a father, brother or son diagnosed before 65, or multiple close relatives diagnosed at any age. The guidelines also advise against screening men whose overall health makes it unlikely they will live another 10 years, and say testing is generally discouraged after age 80.

The new approach reflects years of debate over PSA screening, which can detect tumors early but has also led to unnecessary biopsies and treatment for slow-growing cancers that might never cause symptoms. Past guidance in the US has swung between broad use of PSA tests and more cautious, individualized discussions because of concerns about false positives, overdiagnosis and side effects such as incontinence and sexual dysfunction after aggressive treatment. The cancer society is now trying to balance those risks with mounting evidence that carefully managed screening can lower deaths from prostate cancer, especially among men at higher risk.

To reduce harms, the guidelines stress that a single elevated PSA result should almost always be confirmed with a repeat test before moving to a biopsy, and that doctors should increasingly rely on prostate MRI scans and "active surveillance" to monitor low-risk cancers instead of rushing into surgery or radiation.^[1] That strategy is intended to catch dangerous tumors earlier while avoiding invasive procedures for men whose cancers are unlikely to progress. The society also emphasizes shared decision-making, encouraging physicians to explain the potential benefits and downsides of screening so patients can choose an approach that fits their health, age and preferences.

1. CBS News