Prostate Screening: American Cancer Society Mandates Routine PSA Tests

The American Cancer Society dropped its previous recommendation for men to consult doctors about PSA screening, replacing it with a directive for routine testing. The update, issued on Thursday, signals a fundamental shift in how the medical community approaches one of the most common cancers in the male population.

Men at average risk are now advised to receive a prostate-specific antigen test every two years. This schedule applies to individuals between the ages of 50 and 69. The test is a standard blood draw that measures a protein produced by both normal and cancerous prostate cells. While a high level can indicate a tumor, it may also result from benign enlargement or temporary spikes from exercise.

The guidelines distinguish between risk categories to tailor the frequency of testing. High-risk men, including Black men and those with a strong family history, should start screening earlier at age 45. This group is required to undergo yearly PSA checks rather than the biennial schedule recommended for average-risk patients.

The change reverses the society's position held since 2010. For over a decade, the organization suggested that men discuss the potential benefits and harms of screening with their physicians. That approach was designed to avoid the overtreatment of slow-growing tumors that widespread testing sometimes revealed. Critics argued this ambiguity left many men unsure whether to submit to the test at all.

Dr. Ash Tewari, who leads the urology department at Mount Sinai's Icahn School of Medicine in New York, noted that the new clarity simplifies the process for primary care providers. He stated that the guidelines remove ambiguity by essentially telling doctors to proceed with testing. "They are basically saying, 'Do it,'" Tewari said. He predicted the change would make screening easier for men and help ensure more family members remain present for future dinners.

The society cites advances in medical knowledge as the driver for the update. Improved techniques allow doctors to distinguish between cancers that require immediate intervention and those suitable for monitoring. Strategies include repeating a PSA test to confirm high levels and using MRI scans to identify patients who need a biopsy. For low-risk tumors, the new protocol favors active monitoring over aggressive surgical or radiation treatment.

Dr. Céline Gounder, a CBS News medical correspondent, explained that the timeline for cancer progression supports a more active screening approach. "It takes about 10 years from when you diagnose prostate cancer to until somebody may need surgery," she said. Because doctors can watch and wait rather than jumping to surgery, the society feels comfortable recommending more frequent blood tests.

The guidelines define a strong family history as having one close relative, such as a father, brother, or son, diagnosed with prostate cancer before age 65. It also includes multiple close relatives diagnosed at any age. Men with one close relative diagnosed after 65 should start screening at 45 but can wait two years between tests. The society advises that screening should not continue for men whose health is so poor that they are not expected to live another 10 years.

For men reaching age 70, the guidelines recommend a conversation with a doctor to weigh the benefits against the risks. The society no longer recommends screening at age 75, although it acknowledges that particularly healthy men in that bracket may choose to continue. Screening is generally discouraged once men turn 80. The American Cancer Society estimates that more than 333,000 men in the U.S. will be diagnosed with prostate cancer in 2026, with about 36,000 deaths expected from the disease.