American Cancer Society Updates Prostate Cancer Screening Guideline: Major Changes Include Regular PSA Testing for Average and High-Risk Men
The guideline aims to lower prostate cancer deaths, focusing on clinical management strategies to reduce harms associated with PSA testing
Key Takeaways:
- Regular screening is recommended with a PSA-based test to detect prostate cancer earlier and reduce the risk of diagnosis of advanced prostate cancer and death.
- Updates include recommendations for men at average risk and men who are at higher risk, including Black men and men with a family history of prostate cancer.
- The previous ACS prostate cancer screening guideline did not include a direct recommendation for regular screening, but rather that most men undergo shared decision-making with their healthcare provider about testing for the disease.
- The changes reflect stronger evidence of the benefits of PSA-based screening combined with the increasing use of management strategies that can reduce harms such as unnecessary biopsies and treatment.
Key Screening Recommendations
- Average-Risk Men (Ages 50–69): Recommend a prostate-specific antigen (PSA) blood test every 2 years. Clinicians should discuss potential benefits, limitations, and harms before screening begins.
- Black Men: Recommend annual PSA screening starting at age 45 through age 69, due to higher risk and mortality rates.
- Men with a Strong Family History:
- Recommend annual PSA screening starting at age 45 for men with close relatives (father, brother, or son) diagnosed before age 65, or more than one first-degree relative diagnosed before age 65.
- Recommend screening every 2 years starting at age 45 for non-Black men with a single first-degree relative diagnosed after age 65.
- Ages 70–74: The decision to continue screening should be individualized based on personal health and discussion with a doctor (if continued, every 2 years).
- Ages 75 and Older: Screening is not recommended, nor is it recommended for anyone with a life expectancy of less than 10 years.
Follow-Up and Management Updates
- Elevated PSA Results: An elevated test does not automatically mean cancer. The guideline suggests repeating the PSA test within 2 weeks to 3 months to confirm.
- Secondary Testing: For men with confirmed elevated PSA levels, secondary testing—such as a prostate MRI and/or biomarker tests—is advised before jumping straight to a biopsy.
- Active Surveillance: For men diagnosed with low-risk or slow-growing prostate cancer, active surveillance (closely monitoring with regular PSA tests, MRIs, and biopsies) remains a safe and preferred approach to avoid or delay treatment-related side effects
Source: American Cancer Society
