WASHINGTON (AP) — Middle-aged men should undergo periodic screening for prostate cancer, the American Cancer Society said Thursday in a major update to its guidelines.
The screening involves a simple blood test, and men at average risk should receive a PSA test every two years between ages 50 and 69, the society advised.
Men at higher risk, including Black men and those with a strong family history of prostate cancer, should have annual PSA checks and begin earlier, at age 45.
The guideline update on Thursday marks a shift in the way routine PSA blood testing is viewed.
Since 2010, the society has recommended that men at average risk discuss with their doctors whether PSA testing is appropriate and how often it should be done. PSA is a protein produced by both normal and cancerous prostate cells, meaning a high level could signal a tumor but could also be caused by benign prostate enlargement or a temporary rise from vigorous exercise.
Detecting Prostate Cancer Early Without Overtreatment
Prostate cancer has a very high survival rate when found early, but in the past, widespread PSA testing was blamed for overtreating slow-growing tumors and for follow-up testing that proved unnecessary for men who ultimately did not have cancer.
The updated guidance arrives after advances in understanding how regular PSA testing can help detect prostate cancer before it spreads and becomes harder to treat, as well as how to reduce potential harms of screening. That includes steps like repeating a PSA test to confirm it is truly elevated, adding an MRI to help determine who needs a biopsy, and opting for active surveillance rather than aggressive treatment for low-risk tumors.
A prostate cancer specialist who wasn’t involved in drafting the guideline said the change will be especially beneficial for primary care physicians, who present cancer screening to patients but may be less familiar with its nuances.
“This removes ambiguity. They’re basically saying, ‘Go ahead and do it,’” said Ash Tewari, who heads the Department of Urology at Icahn School of Medicine at Mount Sinai in New York. “This guideline will make things easier for men and, hopefully, within a decade there will be more grandfathers sharing meals with their families.”
Discussing Prostate Cancer Risk with Your Doctor
The guideline emphasizes that a frank conversation between a doctor and patient about the pros and cons remains essential.
“We want to find the right balance,” Tewari agreed. “Patients need to understand that their risk for prostate cancer is not the same as others,” which is why recommendations aren’t identical for everyone.
What constitutes a strong family history? The American Cancer Society defines that as having a close relative—a father, brother, or son—diagnosed with prostate cancer before age 65, or multiple close relatives diagnosed at any age. That places them in the high-risk category for annual PSA screening starting at 45. But if a man has only one close relative diagnosed after 65, he should still begin screening at 45, though he may skip testing every two years in certain intervals.
How long should screening continue? It is not advised for men whose health is such that they are not expected to live another decade. For everyone else, the guideline suggests consulting a doctor at age 70 about the decision, noting that the benefits become less clear. The American Cancer Society no longer recommends screening at age 75—though it recognizes that especially healthy men aged 75 to 79 may opt to continue—and it discourages screening after age 80.
Prostate cancer remains one of the most common cancers among men. The American Cancer Society estimates that more than 333,000 men in the United States will be diagnosed with prostate cancer in 2026, and about 36,000 will die from it.
