Cancer Society Endorses Routine Prostate Screening From 50

The American Cancer Society changed its position on prostate screening. In its first comprehensive overhaul since 2010, the society now recommends regular PSA blood tests for men at average risk — every two years from age 50 through 69.

The old guideline, built around shared decision-making, stopped short of endorsing routine testing. The new one, published in CA: A Cancer Journal for Clinicians, doesn't.

Some men start earlier and test more often. Black men, and men with a strong family history — a first-degree relative diagnosed before 65, or several first-degree relatives with the disease — should screen annually from 45 through 69. Non-Black men with one first-degree relative diagnosed at 65 or older start screening every two years at 45.

A high number isn't a straight line to a biopsy. A confirmed PSA of 3.0 ng/mL or higher in men ages 45 to 69 — or 6.5 in men 70 to 74 — triggers a repeat test within two weeks to three months, then an MRI and/or biomarker tests before biopsy is considered. The guideline doesn't recommend the digital rectal exam as a primary screening tool.

The outer edges are judgment calls. Men ages 70 to 74 should discuss screening, weighing a balance the guideline calls uncertain; it's not recommended at 75 and up, though very healthy men 75 to 79 may discuss it. It's off the table at 80, and for men with a life expectancy under 10 years.

When cancer is found, the guideline leans toward restraint: active surveillance is the preferred approach for low-risk disease.

The stakes sit in the society's own estimates: about 333,830 U.S. men will be diagnosed with prostate cancer in 2026, and 36,320 will die of it. Black men face a 67% higher incidence rate and nearly double the mortality — the disparity the earlier starting age is built to close.