WASHINGTON (AP) — Middle-aged men should undergo regular screening for prostate cancer, the American Cancer Society said Thursday in a major change to its guidelines.
The screening involves a simple blood test, and men at average risk of getting prostate cancer should receive that PSA test every two years between the ages of 50 and 69, the cancer society advised.
Men at high risk, including Black men and men with a strong family history of prostate cancer, should get yearly PSA checks and start earlier, at age 45.
Thursday’s guideline update marks a shift in thinking about routine blood tests for PSA, or prostate-specific antigen.
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Since 2010, the cancer society has recommended that men at average risk talk with their doctors about whether and how often to get PSA tests. That’s a protein produced by both normal and cancerous prostate cells, meaning a high level might signal a tumor but also could be from a benign enlarged prostate or be a temporary spike from vigorous exercise.
Catching prostate cancer early without overtreating
Prostate cancer is highly survivable if caught early, but widespread PSA testing in the past was blamed for overtreatment of slow-growing tumors and unnecessary follow-up testing in men who turned out to not have cancer.
The updated advice comes after advances in understanding how regular PSA testing can help catch prostate cancer before it spreads and becomes harder to treat, as well as how to reduce potential harms from screening, according to the cancer society. That includes steps such as repeating a PSA test to be sure it’s really high or adding an MRI scan to help identify who needs a biopsy, as well as monitoring rather than aggressively treating low-risk tumors.
A prostate cancer specialist not involved with the guideline said the change will be especially helpful for primary care doctors who introduce cancer screenings to patients but may be less familiar with the complexities.
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“This has taken ambiguity out of it. They are basically saying, ‘Do it,'” said Dr. Ash Tewari, who leads the urology department at Mount Sinai’s Icahn School of Medicine in New York. “This guideline will only make things easier for men and hopefully it will have more grandfathers eating dinner with their family 10 years from now.”
Still talk with your doctor about your prostate cancer risk
There still needs to be a doctor-patient conversation about the pros and cons, the cancer society guideline stresses.
“We want to find the right balance,” Tewari agreed. “Patients need to understand that their risk of prostate cancer differs,” which explains why the recommendations aren’t one-size-fits-all.
What is a strong family history? The cancer society says that means having one close relative — a father, brother or son — diagnosed with prostate cancer before age 65, or multiple close relatives diagnosed at any age. That puts them in the high-risk category for yearly PSA checks starting at 45. But if men have just one close relative with prostate cancer diagnosed after 65, they should still start screening at 45 but can go two years between testing.
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How long should screening continue? It’s not for men of any age whose health is so poor that they aren’t expected to live another 10 years. For everyone else, the guideline advises talking with a doctor at age 70 about the choice, saying benefits are less clear. The cancer society no longer recommends screening at 75 — while acknowledging that particularly healthy 75- to 79-year-olds may choose to continue — and discourages it once men turn 80.
Prostate cancer is one of the most common cancers in men. The cancer society estimates more than 333,000 men in the U.S. will be diagnosed with prostate cancer in 2026, and about 36,000 will die of it.
