In reversal, American Cancer Society urges prostate cancer tests for all men

In a significant update to its guidelines for prostate cancer screening, the American Cancer Society is now recommending that all men get routinely screened for prostate cancer with a PSA test.

Men at average risk should get a PSA test every two years from age 50 to 69, according to the new guidelines released Thursday.

Men considered at high risk due to race and family history should start testing earlier, at 45, and most are recommended to get tested every year. Specifically, yearly testing starting at age 45 is recommended for all Black men, who have higher rates of prostate cancer. Non-Black men should also get yearly testing starting at 45 if a close relative was diagnosed with prostate cancer before age 65, or if more than one of their relatives has had prostate cancer. On the other hand, if only one close relative was diagnosed with prostate cancer and it was diagnosed at age 65 or older, non-Black men in this case should start PSA screening at 45, but are recommended to get testing only every two years.

Men ages 70 to 74 should consult their doctor on continuing screening, while those 75 and up are not recommended to get screened.

The new guidance departs from ACS’s previous iteration, published in 2010, which made no universal recommendations for routine screening. Men at age 50 were recommended to use shared-decision making with their doctors on whether or not to get tested. The recommendation was similar to that from the US Preventive Services Task Force, a federal panel that regularly evaluates evidence and makes recommendations on such preventive medical care. (The USPSTF is currently working on an update to its prostate cancer screening recommendation, though it should be noted that the panel has recently been overhauled by anti-vaccine Health Secretary Robert F. Kennedy Jr. and new members are reportedly rife with conflicts of interest.)

New data

In announcing the guidelines today, the ACS says its updates are based on new evidence since 2010 that shows screening saves lives, and that advances in case management can avoid the concerning harms from overdiagnosis and overtreatment. For many men with prostate cancer, their cancer will never grow or cause harm in their lifetime, while treatment can run the risk of erectile dysfunction and urinary incontinence.

In the new guidance, the ACS adds guardrails, firstly advising all men to be informed about the risks and benefits. If a PSA test comes back high—defined as 3 ng/mL or higher for men under 70 and 6.5 ng/mL or higher for those 70 and up—the ACS recommends repeating the test before taking any next steps.

If repeat testing is still high, then men should get either a prostate MRI or a validated biomarker test to assess risk. Only if there is a high suspicion of cancer—such as having a very high PSA test result—should men jump to a prostate biopsy.

For men diagnosed with prostate cancer, active surveillance should be the initial management strategy for men whose cancer appears to be at low risk of growing or spreading.

“By catching aggressive cancers with a simple PSA blood test, you open the door to highly effective treatments that protect your future,” Dr. Shanthi Sivendran, interim chief patient officer for the ACS, said in a statement. “Meanwhile, lower-risk findings can be safely managed through careful, active surveillance.”

Prostate cancer is one of the most common cancers in men and the second leading cause of cancer death in US men, the ACS notes. Nearly 334,00 men are estimated to be diagnosed with prostate cancer in 2026, and it’s estimated that over 36,320 will die from the disease.