American Cancer Society tells men to take PSA tests

The American Cancer Society announced a major update to its prostate cancer screening recommendations on Thursday, advising middle-aged men to undergo regular blood tests. The new guidance instructs men at average risk to receive a prostate-specific antigen, or PSA, test every two years between the ages of 50 and 69.

For men considered high risk, the society recommends starting earlier and testing more often. This group includes Black men and those with a strong family history of the disease. These men should receive yearly PSA checks beginning at age 45.

The society had recommended since 2010 that men at average risk discuss testing frequency with their doctors without a strict mandate. PSA is a protein produced by both normal and cancerous prostate cells. High levels can indicate a tumor, but they can also result from a benign enlarged prostate or temporary spikes caused by vigorous exercise.

The shift in guidelines follows advances in medical understanding regarding how regular testing detects cancer before it spreads. Experts noted that widespread testing in previous decades often led to overtreatment of slow-growing tumors and unnecessary follow-ups for men who did not have cancer. The updated advice incorporates methods to reduce these harms, such as repeating tests to confirm high levels and using MRI scans to identify candidates for biopsy.

Dr. Ash Tewari, a prostate cancer specialist at Mount Sinai's Icahn School of Medicine in New York who was not involved in the guideline, said the change removes ambiguity for primary care doctors. He stated, 'This has taken ambiguity out of it. They are basically saying, Do it.' Tewari added that the guideline will make things easier for men and may result in more grandfathers eating dinner with their families in a decade.

The society emphasizes that a doctor-patient conversation remains necessary to weigh the pros and cons of screening. Tewari agreed, noting, 'We want to find the right balance.' He explained that patients need to understand their individual risk levels, which is why the recommendations are not one-size-fits-all. A strong family history is defined as having a father, brother, or son diagnosed with prostate cancer before age 65, or multiple close relatives diagnosed at any age.

Men with only one close relative diagnosed after age 65 should start screening at 45 but can undergo testing every two years. The guideline advises that men whose health is so poor they are not expected to live another 10 years do not need screening. For everyone else, doctors and patients should discuss the choice at age 70. The society no longer recommends screening at age 75, though healthy men in their late 70s may choose to continue, and it discourages testing after age 80.

Prostate cancer is one of the most common cancers in men. The American Cancer Society estimates that more than 333,000 men in the U.S. will be diagnosed with the disease in 2026. The society projects that about 36,000 men will die of prostate cancer this year.