American Cancer Society Urges PSA Tests Every Two Years From Age 50
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The American Cancer Society is now recommending that most men ages 50 to 69 get a prostate-specific antigen, or PSA, blood test every other year, NBC News reported. Men at higher risk, including Black men and those with close relatives diagnosed with the disease, should be tested annually.
The updated guidelines were published Thursday in CA: A Cancer Journal for Clinicians. They come as rates of advanced prostate cancer keep rising, according to NBC News.
What do the new guidelines say?
For men at average risk, the society now says more emphatically that screening should happen every other year after age 50. Men ages 70 to 74 should talk with their health care providers about whether the test makes sense, based on their health and life expectancy.
Annual screening starting at age 45 is advised for two higher-risk groups: Black men, who have higher rates of prostate cancer and are likelier to die from it, and men whose fathers or brothers were diagnosed under age 65, or who have several relatives diagnosed at any age.
How do they differ from the old advice?
The previous guidelines, issued in 2010, told doctors to discuss with middle-aged men and younger seniors whether they wanted the PSA test. Society experts felt that approach left too many men skipping screening, NBC News reported, so the new version urges doctors to recommend the test to that age group more firmly. Repeat testing used to be based on a PSA-level threshold.
Dr. William L. Dahut, the society's chief scientific officer, said he hoped the change would increase screening among average-risk men and eventually reduce the number who develop metastatic disease or die from it, while limiting harm.
Why did the advice change?
The authors were influenced in particular by a major randomized study of PSA testing in Europe, which now has more than two decades of follow-up. It found that screening middle-aged men did lower prostate cancer deaths, according to NBC News. That and other newer findings let the authors recommend the test with greater confidence and be more specific about who should be tested and how often.
Prostate cancer is the second-leading cause of cancer death among men, behind lung cancer. The death rate has fallen by half over the past three decades, but the decline has slowed overall and has stabilized among men ages 55 to 69.
An American Cancer Society study last year found that diagnoses rose by about 3% annually from 2014 to 2021, and Dahut, a co-author, said the trend has continued. Cases of metastatic prostate cancer rose by about 6% annually among men 55 and older over a decade of data. Among men diagnosed with late-stage disease, only about a third live five more years.
Why has screening advice swung back and forth?
The Food and Drug Administration approved the PSA test for cancer surveillance in 1986. After broad use of the test for screening, late-stage diagnoses dropped by more than half and the death rate fell by 7% by the mid-1990s, NBC News reported.
In the 2000s, health authorities grew concerned about overdiagnosis and narrowed their recommendations. In 2012, the U.S. Preventive Services Task Force recommended against PSA testing for men of any age. Late-stage diagnoses then began to creep up, which prompted concern that less testing was a factor and, eventually, campaigns to broaden testing again.
What does this mean for men and their doctors?
The PSA test can catch prostate cancer earlier, when it is generally more treatable. But it also often finds cancers that will not cause serious illness or death, particularly in the near term. In those cases, men are often better served by ongoing monitoring than by treatment, and many older men die with prostate cancer rather than because of it. For that reason, the society and other health authorities do not recommend the test for men who most likely will not live 10 more years.
The test can also produce false positives that lead to unnecessary treatment and anxiety, and the biopsy needed to confirm a diagnosis carries health risks. Treatment can cause severe effects, including sexual dysfunction, urinary incontinence and bowel problems, though Dahut said improvements in medical practice have helped reduce them.
Doctors are also better able now to tell apart cases that need immediate treatment from those that are better watched over time, NBC News reported. Dr. Daniel George, a medical oncologist at Duke Health who was not involved in the guidelines, said there are more cancer survivors in the U.S. than ever before, and credited more effective therapies rather than overdiagnosis.
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Around Prague, based on reporting by NBC News
Cover photo: Fumikas Sagisavas / Wikimedia Commons (public domain)
