One of the leading cancer organizations in the United States is sounding the alarm about prostate cancer and directly urging men to get screened.
The American Cancer Society has updated its screening guidelines for early detection of prostate cancer to include a direct recommendation of screening every two years, starting at age 50, for men at average risk of developing the disease, and annual screening starting at age 45 for black men as well as those with a strong family history.
The update, published Thursday in CA: A Cancer Journal for Clinicians, marks a significant change from previous screening guidelines, which emphasized “informed decision-making” and encouraged men to discuss prostate cancer screening with a health care provider.
“With this recommendation, we hope that men will seriously consider getting screened for prostate cancer, as we explain in our guidelines. … And once you reach age 70, you’re back in the individual decision-making process,” Dr. William Dahut, chief scientific officer of the American Cancer Society, said of the updated screening guidelines.
The previous screening guidelines were released in 2010, and at the time, “it wasn’t really clear that with prostate screening the benefits outweighed the harms,” Dahut said.
But since then, “two things have happened: First, over time, we have taken steps to minimize the harms of testing,” he said. Second, “we now have long-term data from studies primarily in Europe, in which men who were screened for prostate cancer every two years actually had a decrease in prostate cancer mortality. »
The American Cancer Society says the updated guidelines reflect 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 each physician meant that many men were simply never offered the test. A clear recommendation fixes that problem,” said Dr. Neeraj Agarwal, a medical oncologist and co-director of the Prostate Cancer Program at Dana-Farber Cancer Institute/Harvard Cancer Center, who was not involved in updating the guidelines.
American Cancer Society Prostate Cancer Screening Guidelines
- For men at average risk: PSA-based screening every two years between ages 50 and 69
- For men at high risk: (including black men and non-black men with a first-degree relative diagnosed with a disease before age 65 or multiple first-degree relatives diagnosed at any age) PSA-based screening annually between ages 45 and 69.
- For all men: Individualized decision making for 70 to 74 year olds; no screening recommended for those aged 75 and over
- For men with abnormal PSA levels: retest, preferably two weeks to three months after the initial test, before considering further evaluation
The PSA test is the primary screening tool and the most common method of screening for prostate cancer. It measures the level of prostate specific antigen, or PSA, in a sample of your blood.
PSA is a protein produced by the prostate and high levels of PSA in the blood can be caused by prostate cancer cells. But a high PSA level doesn’t always indicate cancer — it could also be due to an enlarged prostate, common in men as they age., or, less likely, a prostate infection.
The new screening guideline describes an abnormal PSA level as 3 nanograms per milliliter or more for men 69 years old and younger, and 6.5 ng/mL or more for men 70 to 74 years old.
“Your first PSA can be very powerful, especially when it’s obtained between the ages of 40 and 50. 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 American Cancer Society’s updated screening guidelines.
“If that first PSA is below 1 ng/ml, your lifetime risk of prostate cancer is much lower,” Nyame said. “So the first number you get when you’re young can be used as a strategy to improve how you approach screening.”
Prostate cancer is the second leading cause of cancer death among men in the United States, behind lung cancer, and diagnoses are increasing. The rate of diagnosed prostate cancers in the United States increased by about 3% per year between 2014 and 2022, and more advanced-stage cancers were diagnosed during this period.
Many doctors warn that too many prostate cancers are still being discovered even though the disease has become more difficult to treat, suggesting an urgent need for more screening.
“We have seen over the last decade an increase in prostate cancers, primarily driven by men with advanced prostate cancer,” Dahut said. “So please talk to your GP about our updated guidelines and seriously consider prostate cancer screening if you are in this age range.”
It is estimated that approximately 1 in 8 men will be diagnosed with prostate cancer in their lifetime, according to the American Cancer Society.
“This year, more than 330,000 people in the United States will be diagnosed with prostate cancer, and many of them will be cured if their cancer is detected early and treated,” Nyame said.
When prostate cancer is detected early, before it has spread, almost all patients – more than 99% – survive at least the next five years.
“While it has been known for several years that PSA screening in properly selected men saves lives, the evidence on this continues to grow,” said Dr. Justin Gregg, associate professor of urology and health disparities research at the University of Texas MD Anderson Cancer Center, in an email.
A European study published last year in the New England Journal of Medicine found that men who were offered repeat PSA tests were 13 percent less likely to die of prostate cancer than those who were not invited to get screened.
“I am pleased that the American Cancer Society is encouraging PSA-based prostate cancer screening to help save lives,” said Gregg, who was not involved in updating the guidelines. “While removing the term ‘shared decision-making’ may worry some, the document makes it clear that clinicians should consider the benefits, limitations, and harms of PSA screening before a patient decides to begin screening, which is very important. »
However, not all cancer screening guidelines have removed the language of “shared decision making.”
The American Cancer Society’s update comes at a time when federal screening recommendations from the U.S. Preventive Services Task Force continue to emphasize individualized decision-making, recommending that “the decision to undergo periodic prostate cancer screening based on prostate-specific antigen (PSA) should be an individual decision” for men ages 55 to 69.
USPSTF recommendations help guide physicians and inform insurance coverage. Its recommendations receive grades, and the Affordable Care Act requires insurers to cover preventive services that earn an A or B rating from the group, at no cost to patients.
The task force’s recommendation on prostate cancer screening, published in 2018, is graded C. But the task force’s website says the recommendation is currently being updated.
For millions of older Americans, Medicare already covers prostate cancer screening.
“A lot of times, private insurers follow Medicare, but they don’t have to,” Dahut said. And many states have laws requiring private health insurers to cover prostate cancer tests, including the PSA test and digital rectal exams, in which a clinician inserts a gloved finger into a man’s rectum to palpate the prostate for anything abnormal.
“The PSA blood test itself is generally covered. Medicare covers it, and many private plans do as well. The real problem is what comes next. If the PSA is elevated, MRI, biomarker tests, and biopsy are often billed as diagnostic care, so patients can face deductibles and coinsurance. In a large study of privately insured men, more than three-quarters had to pay out of pocket for follow-up testing after a PSA abnormal,” Agarwal said, referring to a published study. in the journal Cancer in 2024.
“A formal recommendation is useful because insurers and policymakers pay attention to the guidelines, and it strengthens the case for coverage that includes the entire journey,” he said. “But coverage mandates generally follow the USPSTF level or new legislation, so I would expect the most significant change to occur if those evolve.”
The role of PSA as a marker to help screen for prostate cancer was discovered in the 1970s. In the early 1990s, it was demonstrated that the PSA blood test could be used as a first-line screening test for prostate cancer.
“It’s been around since the late ’80s. It helps us detect and cure cancers earlier, but PSA tests also have a high false positive rate, meaning the majority of men whose PSA test is abnormal have it because their prostate is enlarged, and the PSA just reflects that effect,” Nyame said.
“So the PSA test is not perfect,” he said. “However, it is an effective way…
Gn Health
