American Cancer Society calls for routine prostate cancer screening in guideline change

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ExpandA big screen in a cricket stadium displays a message of awareness regarding prostate cancer. File picture: Action Images via Reuters/Ed Sykes Story audio is generated using AI

Routine prostate cancer screening is now advised for many men, the American Cancer Society (ACS) announced on Thursday in a major guideline change, saying it believes the possible benefits now outweigh potential harms given medical advances and accumulating evidence.

Its previous guideline issued in 2010 advised men to decide whether to undergo screening after discussing possible advantages and disadvantages with health-care providers.

“Back in 2010, we actually didn’t have a strong opinion on whether or not one should be screened,” said ACS chief scientific officer Dr William Dahut in an interview. “It was unclear at that point whether the potential harms outweighed the benefits.”

An estimated 333,830 US men will be diagnosed with prostate cancer in 2026 and an estimated 36,320 men will die of the disease, the ACS said.

The updated guideline recommends blood tests to measure prostate-specific antigen levels every two years for average-risk men aged 50-69, and annual screening for men with a family history of prostate cancer.

For black men, who have a 67% higher incidence and nearly double the mortality rate compared with white men, it now recommends annual prostate cancer screening for ages 45 to 69.

“By making a direct recommendation for men to engage in screening and advocating for earlier and more frequent screening for black men, our aim is also to help reduce prostate cancer disparities and ease the disease burden,” Dahut said.

The new guidelines — which still say men should receive information about the risks and benefits before PSA testing — now call for a repeat blood test and a magnetic resonance imaging study before a biopsy is scheduled.

The balance of benefits and harms remains uncertain for men aged 70-74, who should discuss screening with their doctors, according to the guideline.

Screening is not recommended for men 75 and older, though some men aged 75-79 who are very healthy may want to continue screening, especially if their PSA level has been rising on previous tests, the ACS says.

Screening is not recommended for men 80 and older or for men who are not expected to live another 10 years.

The possible benefits and harms of universal prostate cancer screening have been hotly debated for years. The fear was that it would identify too many cancers that would never have produced symptoms, in which case treatment could cause side effects such as incontinence and impotence without significant benefits.

The changes, detailed in CA: A Cancer Journal for Clinicians, reflect stronger evidence of the benefits of PSA-based screening combined with the increasing use of management strategies that can reduce harms, such as unnecessary biopsies and treatment side effects, the ACS said.

The new guidelines — which still say men should receive information about the risks and benefits before PSA testing — now call for a repeat blood test and a magnetic resonance imaging study before a biopsy is scheduled.

Men diagnosed with low-risk prostate cancer should initially be offered close monitoring rather than active treatment, the guideline says.

Doctors have got much better at distinguishing men who have high-risk prostate cancer from those who can safely delay treatment, Dahut said.

Treatments now have fewer side effects, robotic surgery has raised the quality of care, and radiation treatments are more targeted and of higher quality, he added.

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