Prostate screening: Cancer society sets specific age and interval rules

The American Cancer Society issued a formal update to its prostate cancer guidelines on Thursday, instructing men to undergo regular screening rather than leaving the decision entirely to individual discussions. The new standards replace a decade-old policy that recommended shared decision-making without specific frequency or age targets for the general population.

Under the revised advice, men with an average risk of developing prostate cancer should receive a prostate-specific antigen, or PSA, blood test every two years. This screening window applies to men between the ages of 50 and 69. The PSA test measures a protein produced by prostate cells, which can indicate the presence of a tumor, though high levels can also result from benign enlargement or physical exertion.

The society identified a distinct high-risk group that requires more frequent monitoring. Black men and those with a strong family history of the disease should begin yearly PSA checks at age 45. A strong family history is defined as one close relative, such as a father, brother, or son, diagnosed with prostate cancer before age 65, or multiple close relatives diagnosed at any age. Men with only one close relative diagnosed after 65 should start screening at 45 but may wait two years between tests.

This shift follows advances in medical understanding regarding how to catch cancer before it spreads while minimizing unnecessary treatment. Past widespread testing was criticized for leading to overtreatment of slow-growing tumors. The new guidelines incorporate strategies to reduce these harms, including repeating tests to confirm high levels, using MRI scans to determine biopsy necessity, and monitoring low-risk tumors rather than immediately treating them.

Dr. Ash Tewari, a prostate cancer specialist at Mount Sinai’s Icahn School of Medicine in New York who was not involved in the guideline process, noted the change removes previous ambiguity. “This has taken ambiguity out of it. They are basically saying, ‘Do it,’” Tewari said. He added that the clearer protocol would help primary care providers and potentially lead to more men living long enough to spend time with their families.

The guidelines maintain that a conversation between the patient and doctor remains necessary to weigh the benefits and risks. Screening is not recommended for men whose health is so poor that they are not expected to live another 10 years. For all other men, the society advises discussing the choice at age 70, noting that benefits become less clear at that stage. The organization no longer recommends screening at age 75, though it acknowledges that particularly healthy men in their late 70s may choose to continue. It discourages testing once men turn 80.

The American Cancer Society estimates that more than 333,000 men in the United States will be diagnosed with prostate cancer in 2026. The group projects that approximately 36,000 men will die from the disease this year.