American Cancer Society no longer advises prostate screening at 75

Strong family history means yearly PSA tests starting at 45, society says

The American Cancer Society defines a strong family history as having one close relative — a father, brother or son — diagnosed with prostate cancer before age 65, or multiple close relatives diagnosed at any age. That puts those men in the high-risk category for yearly PSA checks starting at 45. Men with just one close relative diagnosed after 65 should still start screening at 45 but can go two years between testing.

Screening is not recommended for men of any age whose health is so poor that they are not expected to live another 10 years, the American Cancer Society said Thursday. For everyone else, the guideline advises talking with a doctor at age 70, when benefits are less clear. The society no longer recommends screening at 75 — while acknowledging that particularly healthy 75- to 79-year-olds may choose to continue — and discourages it once men turn 80.

A prostate cancer specialist not involved with the guideline said the change will be especially helpful for primary care doctors who introduce cancer screenings to patients but may be less familiar with the complexities.

“This has taken ambiguity out of it. They are basically saying, ‘Do it,’” said Dr. Ash Tewari, who leads the urology department at Mount Sinai’s Icahn School of Medicine in New York. “This guideline will only make things easier for men and hopefully it will have more grandfathers eating dinner with their family 10 years from now.”

The guideline still requires a doctor-patient conversation about pros and cons, the society stressed. Tewari agreed: “We want to find the right balance,” he said, adding, “Patients need to understand that their risk of prostate cancer differs,” which explains why the recommendations are not one-size-fits-all.

Thursday’s guideline update marks a shift in thinking about routine blood tests for PSA, or prostate-specific antigen, and moves the society from advice to schedule: men at average risk of prostate cancer should get a PSA blood test every two years between the ages of 50 and 69, while men at high risk — including Black men and men with a strong family history of prostate cancer — should get yearly PSA checks and start earlier, at age 45. Since 2010, the cancer society has recommended that men at average risk talk with their doctors about whether and how often to get PSA tests.

The screening itself is a simple blood test. Prostate-specific antigen is a protein produced by both normal and cancerous prostate cells, meaning a high level might signal a tumor but also could be from a benign enlarged prostate or be a temporary spike from vigorous exercise. Prostate cancer is highly survivable if caught early, but widespread PSA testing in the past was blamed for overtreatment of slow-growing tumors and unnecessary follow-up testing in men who turned out not to have cancer.

The updated advice comes after advances in understanding how regular PSA testing can help catch prostate cancer before it spreads and becomes harder to treat, as well as how to reduce potential harms from screening, according to the cancer society. Those steps include repeating a PSA test to be sure it’s really high, adding an MRI scan to help identify who needs a biopsy, and monitoring rather than aggressively treating low-risk tumors.

Prostate cancer is one of the most common cancers in men. The American Cancer Society estimates more than 333,000 men in the U.S. will be diagnosed with prostate cancer in 2026, and about 36,000 will die of it.