Middle-aged men should be screened regularly for prostate cancer, the American Cancer Society said Thursday, in a major change to its guidelines.
Screening involves a simple blood test, and men at average risk of developing prostate cancer should have a prostate-specific antigen, or PSA, test every two years between the ages of 50 and 69, the cancer society has advised.
High-risk men, including black men and men with a strong family history of prostate cancer, should have annual PSA checks and start earlier, at age 45.
Thursday’s guideline update marks a shift in thinking about routine blood testing for PSA, or prostate specific antigen.
Since 2010, the Cancer Society has recommended that men at average risk talk to their doctor about the appropriateness and frequency of PSA testing. It is a protein produced by normal and cancer cells in the prostate, meaning a high level can signal a tumor, but can also come from benign prostate enlargement or a temporary spike from vigorous exercise.
Detecting prostate cancer at an early stage without overtreating it
Prostate cancer offers a high chance of survival if detected early, but in the past, widespread PSA screening tests were blamed for overtreatment of slow-growing tumors and unnecessary follow-up testing in men who were found to be cancer-free.
This updated advice follows advances in understanding how regular PSA testing can help detect prostate cancer before it spreads and becomes more difficult to treat, as well as how to reduce the potential harms of screening, according to the cancer society. This includes steps like repeating a PSA test to make sure it’s truly elevated or adding an MRI to help identify who needs a biopsy, as well as monitoring rather than aggressively treating low-risk tumors.
“It takes about 10 years from being diagnosed with prostate cancer to when someone needs surgery, and we’re watching and waiting a lot longer, so it makes sense that you can now be a little more aggressive with PSA. You don’t have to go to surgery and watch and wait to see what you need to do,” said CBS News medical correspondent Dr. Celine Gounder.
A prostate cancer specialist not involved in the guidelines said the change would be particularly helpful for primary care doctors who introduce cancer screening to patients but might be less familiar with the complexities.
“It removed any ambiguity. They’re basically saying, ‘Do it,'” said Dr. Ash Tewari, who heads the department of urology at the Icahn School of Medicine at Mount Sinai in New York. “This directive will only make things easier for men and hopefully more grandfathers will be dining with their families in 10 years.”
Talk to your doctor about the risk of prostate cancer
There still needs to be a doctor-patient conversation about the pros and cons, the cancer society’s guideline emphasizes.
“We want to find the right balance,” admitted Tewari. “Patients need to understand that their risk of prostate cancer differs,” which explains why the recommendations are not universal.
What is a strong family history? The Cancer Society says this means a close relative – a father, brother or son – was diagnosed with prostate cancer before age 65, or multiple close relatives were diagnosed at any age. This puts them in the high-risk category for annual PSA checks starting at age 45. But if men have only one close relative with prostate cancer diagnosed after age 65, they should still start screening at age 45, but can wait two years between tests.
How long should screening continue? It is not for men of any age whose health is so poor that they are not expected to live another 10 years. For everyone else, the guidelines advise discussing the choice with a doctor at age 70, saying the benefits are less clear. The cancer society no longer recommends screening at age 75 – while recognizing that particularly healthy people aged 75 to 79 may choose to continue – and discourages it once men reach 80.
Prostate cancer is one of the most common cancers among men. The Cancer Society estimates that more than 333,000 men in the United States will be diagnosed with prostate cancer in 2026 and about 36,000 will die from it.
Most prostate cancers don’t cause symptoms at first, but signs can include changes in urination, blood in urine or semen, and lower body pain, according to the CDC. Most early signs occur when a growing tumor puts pressure on the urinary tract.
Gn Health
