New prostate cancer guidance: regular PSA screening recommended from age 50

The American Cancer Society has issued new guidance on prostate cancer screening. In the updated guidance released on November 12, men at average risk are recommended to start regular screening at age 50. The update moves away from emphasising individual decisions about screening and now explicitly recommends regular testing for eligible men.

Under the new guidance, average-risk men aged 50 through 69 should have a PSA test every two years. Black men should begin annual screening at 45, regardless of family history.

Other men whose father, brother or son has been diagnosed with prostate cancer should also begin at 45, with the frequency depending on their family history.

Men aged 70 to 74 should discuss with their doctors whether to continue screening; routine screening is not recommended at 75 and older.

Prostate cancer is the second-leading cause of cancer death among men in the United States. According to the American Cancer Society, for disease that has not spread beyond the prostate or nearby areas, the five-year relative survival rate is nearly 100 percent.

The screening is a simple blood test for PSA, or prostate-specific antigen, a protein produced by normal and cancerous cells in the prostate gland. Under the updated guidance, a PSA level of 3 nanograms per millilitre or higher in men younger than 70 warrants a repeat test to confirm the result.

There are other explanations for a higher PSA level besides prostate cancer, such as an enlarged prostate, inflammation or an infection. So a high result does not by itself mean cancer.

Screening can also identify slow-growing cancers that may never cause harm. The society therefore recommends discussing the benefits and possible harms of screening with a healthcare provider and offering close monitoring as an initial approach for low-risk cancers.

Dr Ash Tewari, chair of the Milton and Carroll Petrie Department of Urology at the Icahn School of Medicine at Mount Sinai in New York City, said men think it is going to happen to someone else. He has performed more than 10,000 prostate cancer operations and said the success rate of treating patients is exceedingly high, but many men still need to be nudged to get screened.

Dr Tewari said, "We know how to cure 95% of them." In his words, he can operate and medications have been developed — the key is to reach patients in time. To reach more men, he and Mount Sinai have created mobile prostate cancer screening vehicles so men can be examined where they live.

The first bus, the Mount Sinai Robert F. Smith Mobile Prostate Cancer Screening Unit, was sent out in New York City in 2022. Last month, another bus was deployed to the Atlanta Falcons-Chicago Bears game at Mercedes-Benz Stadium in Atlanta. The Winship Cancer Institute at Emory University offered free screenings in partnership with the Atlanta Falcons during the game.

The American Cancer Society estimates that more than 333,000 men in the U.S. will be diagnosed in 2026, and about 36,000 will die from the disease. Last month, actress Brooke Shields joined Dr Tewari and directed a public service announcement advocating screening and early detection.

The goal of Dr Tewari's Million Strong Men Initiative is to screen more than one million men for prostate cancer. In the announcement, Shields said prostate cancer is treatable when detected early. Her father, Frank, died of prostate cancer in 2003 at 61 years old.

Dr Tewari said, "Prostate cancer is often a disease that families don't talk about until there is a reason to." In his words, starting the conversation early can give men an opportunity to learn about their risk, talk with their doctors about screening and act when appropriate.