A ‘clear recommendation’ for men: Get screened for prostate cancer - CNN

The American Cancer Society has updated its screening guidelines for the early detection of prostate cancer to include a direct recommendation for screening every two years, starting at age 50, for men at average risk of the condition, and annual screening starting at 45 for Black men as well as those with a strong family history.

The update, published Thursday in CA: A Cancer Journal for Clinicians, marks a significant shift from the previous screening guidelines, which emphasized “informed decision-making” that urged men to discuss prostate cancer screening with a health care provider.

“We’re hopeful with this recommendation that men seriously consider being screened for prostate cancer as we outline in our guidelines. … And once you hit age 70, then you’re back in the individual decision-making process,” Dr. William Dahut, chief scientific officer of the American Cancer Society, said about the updated screening guideline.

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The previous screening guideline was published in 2010, and at that time, “it wasn’t really clear at that point that with prostate screening, the benefits outweigh the harms,” Dahut said.

But since then, “two things have been happening: First of all, over time, we’ve been doing things to minimize the harms of screening,” he said. Second, “we now have long-term data from studies done primarily in Europe, where men who have been screened for prostate cancer every two years actually have a decrease in prostate cancer mortality.”

The American Cancer Society says the updated guideline reflects stronger evidence showing that screening for prostate cancer with a PSA test significantly reduces the risk of dying from the disease.

“Leaving it to each patient and doctor meant a lot of men were simply never offered the test. A clear recommendation fixes that,” said Dr. Neeraj Agarwal, medical oncologist and co-director of the Prostate Cancer Program at the Dana-Farber Cancer Institute /Harvard Cancer Center, who was not involved in the updated guideline.

American Cancer Society prostate cancer screening guideline

- For men at average risk: PSA‐based screening every two years from ages 50 through 69

- For men at high risk: (including Black men, and non-Black men with a first-degree relative who was diagnosed with the disease before age 65 or multiple first‐degree relatives who were diagnosed at any age) PSA‐based screening every year from ages 45 through 69

- For all men: Individualized decision‐making for ages 70 through 74; no screening recommended in 75 and older

- For men with abnormal PSA levels: retest, preferably two weeks to three months after the initial test, before considering further evaluation

A PSA test is the main screening tool and most common method of screening for prostate cancer. It measures the level of prostate-specific antigen, or PSA, in a sample of your blood.

PSA is a protein produced by the prostate gland, and high levels of PSA in the blood may be caused by cancerous cells in the prostate. But an elevated PSA does not always indicate cancer – it could also be due to an enlarged prostate, common for men as they age, or, less likely, prostate infection.

The new screening guideline describes an abnormal PSA level as being 3 nanograms per milliliter or higher for men 69 and younger, and 6.5 ng/mL or higher for men 70 to 74.

“Your first PSA can be really powerful, especially when obtained in your 40s and 50s. It establishes a baseline,” said Dr. Yaw Nyame, a physician and associate professor at the Fred Hutchinson Cancer Center who served on the expert panel that reviewed the American Cancer Society’s updated screening guideline.

“If that first PSA is under 1 ng/ml, your lifetime risk of prostate cancer is much lower,” Nyame said. “So that first number you get when you’re young can be used as a strategy to improve the way that you approach screening.”

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Prostate cancer is the second-leading cause of cancer death among men in the US, behind only lung cancer, and diagnoses have been on the rise. The rate of prostate cancers diagnosed in the US climbed about 3% per year from 2014 through 2022, and there have been more late-stage cancers diagnosed during this time.

Many physicians warn that too many prostate cancers are still being found after the disease has become more difficult to treat, suggesting an urgent need for more screening.