Cancer Group Mandates Biennial PSA Screening

The American Cancer Society issued new screening guidelines on Thursday, advising men between the ages of 50 and 69 to receive a prostate-specific antigen, or PSA, blood test every two years. Men at high risk, including Black men and those with strong family histories, should begin annual testing at age 45. This represents the first major update to the society's prostate cancer screening guidance in more than a decade.

The shift moves away from previous advice that encouraged men to discuss screening options with doctors without directly recommending a specific test. Dr. William Dahut, the society's chief scientific officer, stated the goal is to reduce metastatic diagnoses and deaths while minimizing the harm from unnecessary procedures. The updated rules pair the initial blood test with follow-up steps designed to lower the rate of false positives and overdiagnosis.

Prostate cancer affects more than 300,000 men in the United States annually, with approximately 36,000 dying from the disease. It is the second leading cause of cancer death among men. Black men are twice as likely to die from the condition compared to white men. The guidelines define high risk as having a first-degree relative diagnosed before age 65 or multiple first-degree relatives diagnosed at any age.

Dr. Adam Feldman, chief of urologic oncology at Mass General Brigham Cancer Institute, noted that the new rules emphasize the value of early detection. He stated that finding the disease at an earlier stage improves treatment outcomes for patients.

Currently, only about 40 percent of men aged 55 to 69 receive a PSA test within a given year, according to the National Cancer Institute. The rate is lower among Black men, standing at approximately 33 percent. Dahut said that increasing screening frequency and starting earlier aims to reverse mortality disparities.

For men aged 70 to 74, the guidelines recommend individualized decision-making, citing uncertainty regarding the balance of benefits and harms. Screening is generally not recommended for men 75 and older, as the potential harms of therapy often outweigh the benefits. Men with elevated PSA levels, defined as 3 ng/mL or higher for ages 45 to 69 and 6.5 ng/mL or higher for ages 70 to 74, must undergo repeat testing between two weeks and three months.

Confirmed elevated results should trigger further testing, including magnetic resonance imaging and biomarker tests, before a biopsy is performed. Men diagnosed with low-risk cancer should be offered active surveillance as the initial management option. Dr. Neeraj Agarwal, a medical oncologist at Dana-Farber Cancer Institute, warned that increasing access to MRIs and biopsies is essential to ensure men with the most to gain complete the diagnostic process.

Health Secretary Robert F. Kennedy Jr. recently replaced two leaders of the US Preventive Services Task Force, which is currently updating its own recommendations from 2018. Dr. Glen McWilliams, a urologic oncologist and trustee of the National Medical Association, suggested that Black men with aggressive family histories consider screening as young as 35. In October, Boston Medical Center launched a mobile van to provide free PSA tests and education in local communities.