One of the leading cancer organisations in the United States is raising the alarm over prostate cancer and directly urging men to get screened, in a major shift in medical guidance.
The American Cancer Society has updated its screening guidelines for the early detection of prostate cancer to include a direct recommendation for screening every two years, starting at age 50, for men at average risk of the condition. Men at higher risk, including Black men and those with a strong family history of the disease, should be screened annually starting at 45.
The update, published on Thursday in CA: A Cancer Journal for Clinicians, marks a significant shift from the previous screening guidelines, which emphasised “informed decision-making” and urged men to discuss prostate cancer screening with a health care provider before deciding.
“We’re hopeful with this recommendation that men seriously consider being screened for prostate cancer as we outline in our guidelines. And once you hit age 70, then you’re back in the individual decision-making process,” Dr William Dahut, chief scientific officer of the American Cancer Society, said about the updated guideline.
The previous screening guideline was published in 2010, and at that time, Dahut said, “it wasn’t really clear at that point that with prostate screening, the benefits outweigh the harms”. Since then, he said, steps have been taken to minimise the harms of screening, and long-term data from studies done primarily in Europe show that men screened for prostate cancer every two years have a decrease in prostate cancer mortality.
The American Cancer Society says the updated guideline reflects stronger evidence showing that screening for prostate cancer with a PSA test significantly reduces the risk of dying from the disease. “Leaving it to each patient and doctor meant a lot of men were simply never offered the test. A clear recommendation fixes that,” said Dr Neeraj Agarwal, a medical oncologist and co-director of the Prostate Cancer Program at the Dana-Farber Cancer Institute and Harvard Cancer Center, who was not involved in the updated guideline.
A PSA test is the main screening tool for prostate cancer. It measures the level of prostate-specific antigen, a protein produced by the prostate gland, in a blood sample. An elevated PSA does not always indicate cancer; it could also be due to an enlarged prostate, which is common as men age, or, less likely, an infection.
The new guideline describes an abnormal PSA level as 3 nanograms per millilitre or higher for men aged 69 and younger, and 6.5 ng/mL or higher for men aged 70 to 74. “Your first PSA can be really powerful, especially when obtained in your 40s and 50s. It establishes a baseline,” said Dr Yaw Nyame, a physician and associate professor at the Fred Hutchinson Cancer Center who served on the expert panel that reviewed the guideline. “If that first PSA is under 1 ng/ml, your lifetime risk of prostate cancer is much lower.”
Prostate cancer is the second-leading cause of cancer death among men in the US, behind only lung cancer, and diagnoses have been rising — up about 3 percent per year from 2014 through 2022, with more late-stage cancers found. Dahut urged men to talk to their primary care doctor about screening.
