New prostate cancer screening guidelines include regular testing for most older men

More than 330,000 men in the United States are expected to be diagnosed with prostate cancer this year and about 36,000 will die from it, making it the second-leading cause of cancer death among men. The American Cancer Society updated its guidelines Thursday, published in CA: A Cancer Journal for Clinicians, marking its first revision since 2010. The new guidance calls for PSA-based screening every two years starting at age 50 for men at average risk and annual screening from 45 for Black men and those with a first-degree relative diagnosed before 65 or multiple relatives at any age. For men 70 to 74, the society says the balance of benefits and harms remains uncertain and recommends individualized decisions; screening is not recommended for most men 75 and older.

The shift reflects long-term data from European studies showing that repeated PSA testing every two years reduced prostate cancer mortality by 13 percent compared with no invitation to screen. Dr. William Dahut, the society's chief scientific officer, said the evidence now shows that benefits outweigh harms, especially after advances such as MRI and biomarker tests that help avoid unnecessary biopsies and treatment of low-risk disease. An abnormal PSA is defined as 3 ng/mL or higher for men 69 and younger and 6.5 ng/mL or higher for men 70 to 74; confirmed elevations should trigger further imaging and biomarker testing before a biopsy.

Prostate cancer disproportionately affects Black men, who are twice as likely to die from the disease as white men. In 2023, only about 33 percent of Black men aged 55 to 69 had received a PSA test in the prior year, compared with about 40 percent of men overall in that age group. Dr. Glen McWilliams, a urologic oncologist and trustee of the National Medical Association, said some experts believe Black men with relatives diagnosed at younger ages should consider screening as early as 35. The society hopes earlier and more frequent screening will reverse mortality disparities.

The U.S. Preventive Services Task Force still recommends individualized decision-making for men 55 to 69, a 2018 guideline graded C that is currently being updated. USPSTF grades affect insurance coverage under the Affordable Care Act, while Medicare already covers PSA screening. Dr. Neeraj Agarwal of Dana-Farber Cancer Institute warned that follow-up MRI, biomarker tests and biopsies are often billed as diagnostic care, leaving patients with deductibles and coinsurance; a 2024 study in Cancer found more than three-quarters of privately insured men faced out-of-pocket costs after an abnormal PSA.

The new guidelines also recommend active surveillance as the initial management option for men diagnosed with low-risk prostate cancer. Dr. Dahut said combining imaging, biomarkers and deferred treatment for low-grade disease can mitigate harm. Boston Medical Center recently launched a mobile screening van to bring free PSA tests and education into communities, aiming to increase both screening and access to the full diagnostic pathway.