300,000: Annual prostate cancer diagnoses drive new ACS screening rules

The American Cancer Society issued its first major update to prostate cancer screening guidelines in over ten years on Thursday. The new rules advise men aged 50 to 69 to receive prostate-specific antigen, or PSA, blood tests every two years. For men identified as high risk, including Black men and those with strong family histories, the guidance calls for annual testing starting at age 45.

Prostate cancer remains the second leading cause of cancer death among men in the United States. More than 300,000 men are expected to receive a diagnosis this year, with approximately 36,000 projected to die from the disease. Black men face a disproportionately higher risk, dying from the condition at twice the rate of white men. Current data shows that only about 40 percent of men aged 55 to 69 received a PSA test in the year prior to 2023. The rate was lower for Black men, standing at roughly 33 percent.

Dr. William Dahut, chief scientific officer at the American Cancer Society, stated that the goal is to reduce metastatic diagnoses and mortality while minimizing treatment harms. The guidelines move away from a previous approach that recommended individualized decision-making without a specific test frequency. Instead, the update pairs PSA screening with additional diagnostic tools to prevent unnecessary procedures. Men with confirmed elevated PSA levels should be offered magnetic resonance imaging and biomarker tests before a biopsy is performed.

Specific thresholds guide the next steps for testing. Men aged 45 to 69 with PSA levels of 3 ng/mL or higher, and men aged 70 to 74 with levels of 6.5 ng/mL or higher, should undergo repeat testing within two weeks to three months. For men diagnosed with low-risk cancer, the guidelines recommend active surveillance as the initial management option rather than immediate treatment. Screening is generally not recommended for most men aged 75 and older, as the harms of therapy are likely to outweigh the benefits.

Experts noted that the society was among the last major groups to avoid direct test recommendations. Dr. Adam Feldman, chief of the division of urologic oncology at the Mass General Brigham Cancer Institute, said the update highlights the value of early detection. Dr. Glen McWilliams, a urologic oncologist and trustee of the National Medical Association, suggested that some Black men might consider screening as early as age 35 if they have relatives diagnosed with aggressive cancer before age 40. He noted that patients are often diagnosed with significant disease before their 40th birthday.

Access to follow-up care remains a challenge. Dr. Neeraj Agarwal, a medical oncologist at Dana-Farber Cancer Institute, warned that men with the most to gain from screening may not complete the necessary workup if MRI and biopsy access are limited. In Boston, Boston Medical Center launched a mobile screening van in October to provide free PSA tests and education. Dr. Toby Chai, chief of urology at the center, said the goal is to provide information so patients understand the best course of action.