The American Cancer Society issued updated prostate cancer screening guidance on November 12, its first comprehensive revision since 2010, and for the first time it directly recommends regular screening rather than leaving the choice to an informed individual decision. Average risk men aged 50 to 69 should have a PSA blood test every two years, the guideline says, published in CA: A Cancer Journal for Clinicians.
Higher risk men start earlier and test more often. Black men and men with a strong family history, meaning a first degree relative diagnosed before 65 or multiple affected relatives, should be screened annually from age 45 through 69. Non-Black men with one first degree relative diagnosed at 65 or older should begin biennial screening at 45. Reuters reported the society’s figures that Black men face a 67 percent higher incidence of prostate cancer and nearly double the mortality rate of white men.
The guideline also disciplines what happens after a high result. A confirmed PSA of 3.0 ng/mL or higher in men aged 45 to 69, or 6.5 ng/mL or higher at ages 70 to 74, should trigger a repeat test within two weeks to three months, then MRI and or biomarker testing to guide any biopsy decision. For low risk cancers found on biopsy, active surveillance is the preferred first approach. The evidence synthesis leaned on long term European trial data showing about a 20 percent relative reduction in prostate cancer mortality with screening invitations (risk ratio 0.80, 95 percent confidence interval 0.72 to 0.89).
The balance of benefits and harms is still called uncertain for men aged 70 to 74, who should decide with their doctors, and screening is not recommended at 80 or older, or for men not expected to live another ten years. Men must still be told the risks and benefits before testing begins. The practical effect is a larger, steadier flow of PSA testing, confirmatory imaging and biomarker work, with the overdiagnosis argument now carried by the follow up protocol rather than by not testing at all.