A new American Cancer Society (ACS) guideline calls for prostate-specific antigen (PSA) tests every two years for average-risk U.S. men ages 50 to 69, replacing a largely individualized approach with a defined schedule.
The report was first published online Nov. 12 in CA: A Cancer Journal for Clinicians. Before testing, ACS says men should be told about screening’s potential benefits, limits and possible harms. Its 2010 advice had asked most men to decide with a clinician whether to screen.
The guideline defines an elevated result as at least 3.0 nanograms per milliliter (ng/mL) for men 69 and younger, or 6.5 ng/mL for men ages 70 to 74. ACS recommends repeating an elevated result, preferably after two weeks to three months. If it remains high, an MRI and/or a validated biomarker can help determine whether a biopsy is appropriate. For low-risk prostate cancer, active surveillance should initially be offered.
For men ages 70 to 74, ACS recommends making the screening decision with a clinician, weighing health, preferences and the uncertain balance of benefits and harms. Men who continue should test every two years. The society advises against population screening from age 75 and against screening when life expectancy is under 10 years. Some very healthy men ages 75 to 79 who ask about continuing may discuss it with a clinician after learning that the benefit is unproven and potential harms are higher.
The earlier schedule is yearly testing, starting at 45 and ending at 69, for Black men and non-Black men whose family history meets the guideline’s high-risk definition. That means multiple first-degree relatives diagnosed at any age, or one such relative diagnosed before 65. A non-Black man with one first-degree relative diagnosed at 65 or older is advised to test every two years from ages 45 to 69.
The average-risk recommendation received a B grade, with moderate-certainty evidence. The recommendation for Black men is a consensus statement, with low certainty for choosing age 45 as the starting point. Family-history guidance is also consensus-based because direct evidence is limited.
ACS says evidence that screening reduces prostate cancer deaths and advanced-stage diagnoses has strengthened since 2010, and follow-up methods have improved. The society estimates 333,830 U.S. men will be diagnosed with prostate cancer in 2026 and 36,320 will die. Dr. Robert Smith, ACS senior vice president for early cancer detection science and a report co-author, said, “PSA testing remains the cornerstone of detecting prostate cancer early.”
Follow-up may involve repeat tests, specialist referrals and MRI, as well as travel or delays in care. The society’s advocacy affiliate says patient payments can make screening and follow-up harder to access; financial costs were not part of the guideline’s formal grading. ACS calls the document a living guideline that will be updated periodically but has not announced a date for its next update.
