The organization now recommends routine PSA-based prostate cancer screening every two years for average-risk men ages 50-69, citing new evidence that screening lowers mortality and advanced-stage diagnoses.
The American Cancer Society (ACS) has released an updated prostate cancer screening guideline that directly recommends prostate-specific antigen (PSA)-based screening every two years for average-risk men aged 50 to 69. Clinicians should first make sure patients understand the potential benefits, limitations, and harms of screening.
The guideline also recommends annual PSA-based screening beginning at age 45 for Black men and for men with a strong family history of prostate cancer. It is published in CA: A Cancer Journal for Clinicians, the society’s flagship journal.
According to ACS, evidence gathered since the previous guideline was published in 2010 shows that PSA screening significantly reduces prostate cancer mortality and the diagnosis of advanced-stage disease. The society also points to advances in how elevated PSA results are handled that can reduce the harms of diagnosing and treating prostate cancers that may not be life-threatening.
“PSA testing remains the cornerstone of detecting prostate cancer early, and we now have stronger evidence of its benefits,” says Robert Smith, PhD, senior vice president of early cancer detection science and director of the Center for Early Cancer Detection at the American Cancer Society and senior author of the report, in a release.
PSA as the First Step in a Screening Process
Smith emphasizes that a PSA test, a blood test that measures the level of prostate-specific antigen, is only the first step. Secondary testing for men with elevated PSA levels determines who needs a biopsy. If cancer is found, further evaluation determines who needs immediate treatment and who can be safely monitored through active surveillance.
“We also have better approaches to catching lethal tumors while avoiding unnecessary tests for slow-growing cancers that may never need aggressive care,” says Smith, in a release.
To update the guideline, ACS conducted a systematic evidence review and commissioned a modeling study to evaluate the benefits and harms of PSA-based screening strategies. An interdisciplinary volunteer Guideline Development Group, including clinicians, epidemiologists, biostatisticians, and patient representatives, was charged with the update.
The society says the revised recommendations are intended to reduce uncertainty about the effectiveness of prostate cancer screening and to emphasize earlier identification of clinically significant cancers, particularly among men at increased risk. They are also meant to help avoid aggressive treatment of cancers that are not life-threatening.
ACS describes the guideline as a “living guideline.” Its scientists and volunteers will continue to monitor the evidence for new screening and treatment strategies, and the guideline will be updated periodically.
Disparities and Access
Prostate cancer is among the most common cancers in men and is the second leading cause of cancer death in men in the US. ACS estimates that 333,830 men will be diagnosed with the disease in 2026, and 36,320 will die from it. Incidence and mortality rates vary substantially across racial and socioeconomic groups.
“Black men experience a 67% higher incidence and nearly double the mortality rate compared with White men, an inequity that needs immediate reversal,” says William Dahut, MD, chief scientific officer at the American Cancer Society and a contributing author of the study, in a release. He adds that the direct recommendation for screening, along with earlier and more frequent screening for Black men, is intended to help reduce disparities and ease the disease burden.
The society’s advocacy affiliate, the American Cancer Society Cancer Action Network (ACS CAN), says it will push for coverage of prostate screening services, including follow-up testing, with no cost sharing.
“Early detection of cancer can save lives. However, cost sharing or out-of-pocket costs can be a significant hurdle to getting the prostate cancer screenings needed to detect the disease early,” says Lisa A. Lacasse, president of ACS CAN, in a release.
The guideline report also includes a patient page, a concise, structured resource from the journal that addresses typical patient questions about screening and treatment options.
“Think of prostate cancer screening as an early warning system for your health,” says Dr Shanthi Sivendran, interim chief patient officer for the American Cancer Society, in a release. She adds that lower-risk findings can be safely managed through active surveillance.
ACS researchers Dr Deana Baptiste, Tyler Kratzer, MPH, and Dr Hormuzd Katki also contributed to the report.
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