For decades, American men have been asked to weigh a blood test for prostate cancer largely on their own, and the American Cancer Society has now stepped forward to say the scales tip toward testing. Its update, published in CA: A Cancer Journal for Clinicians, sets a clear rhythm: a PSA every two years beginning at 50 for most men, and annually from 45 for Black men and those with a strong family history. The shift reflects long-term European evidence that regular screening saves lives, weighed against a history of false alarms and overtreatment that still shadows the test. What remains unset
American Cancer Society Urges Men to Get Prostate Cancer Screened, Lowering Its Recommended Starting Ages
Prostate cancer is the second-leading cancer death among US men, and late-stage diagnoses have risen about 3% per year from 2014 through 2022.
Every year matters, and if you delay the screening, you lose the window.
Mark
What actually changed here? Doctors already talked about PSA tests.
Mimi
The wording changed from "discuss it" to "do it." Screening every two years from 50, and yearly from 45 for Black men and men with strong family history.
Luke
And the basis is what, exactly?
Mimi
Long-term European data, including a New England Journal of Medicine study showing 13% lower prostate cancer mortality among men invited to repeated testing.
Luke
That's one study's figure, and it's about being invited to screen, not necessarily everyone tested. Worth keeping straight.
Mark
Why not just keep the old approach?
Mimi
Agarwal argues that leaving it to patient and doctor meant many men were never offered the test at all.
Luke
That's his view, though, not a measured number. The article doesn't say how many were missed.
Mark
What about the downsides?
Mimi
False positives are common, usually from an enlarged prostate. But MRI and biomarkers now help avoid unnecessary biopsies and treatment.
Luke
Still, the federal task force hasn't moved. Its 2018 grade is a C, so no-cost coverage isn't mandated, and the costs of follow-up testing are real.
Mimi
Right, and Agarwal thinks Black men should start near 40, not 45. Experts disagree on that.
Luke
Which the reporting leaves unresolved. We don't know when the task force update will land.
El Pulso
- The American Cancer Society has abandoned its earlier 'informed decision-making' language and now directly urges PSA screening, a reversal that lands squarely on a debate that has divided doctors for over a decade.
- Prostate cancer is the second-leading cancer killer of American men, and late-stage diagnoses have been climbing about 3% a year, giving the recommendation real urgency.
- Most abnormal PSA results come from an enlarged prostate rather than cancer, so follow-up MRIs and biopsies become the frontline of anxiety, unnecessary procedures and out-of-pocket bills.
- The federal task force still grades routine screening a C and calls it an individual choice, leaving insurance coverage in limbo until its pending revision arrives and reshapes what patients pay.
For decades, American men have been asked to weigh a blood test for prostate cancer largely on their own, and the American Cancer Society has now stepped forward to say the scales tip toward testing. Its update, published in CA: A Cancer Journal for Clinicians, sets a clear rhythm: a PSA every two years beginning at 50 for most men, and annually from 45 for Black men and those with a strong family history. The shift reflects long-term European evidence that regular screening saves lives, weighed against a history of false alarms and overtreatment that still shadows the test. What remains unsettled is who pays for the path that follows an abnormal result, and whether the national task force will move its own hand.
The American Cancer Society has stopped hedging on prostate cancer screening. Its new guidance directly recommends a PSA blood test every two years starting at 50 for men at average risk, and yearly testing from 45 for Black men and those with a strong family history. It replaces a 2010 position that asked men to simply talk with their doctors about whether to be tested.
Dr. William Dahut, the society's chief scientific officer, explained that the evidence has shifted. Screening methods now carry fewer harms, and long-term European data show lower prostate cancer deaths among men tested regularly. After age 70, the decision returns to the individual.
The urgency is rooted in the numbers. Prostate cancer is the second-leading cause of cancer death among American men, and diagnoses have risen about 3% a year since 2014, with more cases caught late. Dr. Yaw Nyame of Fred Hutchinson noted that when caught early, more than 99% of patients survive at least five years.
The test remains imperfect. Most abnormal results stem from an enlarged prostate rather than cancer, and screening can trigger anxiety and unneeded treatment. That memory drove the 2012 federal advice against routine testing, and screening rates fell afterward. Nyame and colleagues now see more aggressive cancers and men arriving with very high PSA levels. Newer MRI and genomic tools now help doctors target biopsies and safely watch low-risk cancers.
The federal task force still grades routine screening a C and leaves it to the individual, so insurance obligations under the Affordable Care Act remain uncertain, though an update is under review. Dr. Neeraj Agarwal warned that the real burden falls on follow-up care, where more than three-quarters of privately insured men in one study faced out-of-pocket costs after an abnormal result.
For Black men, Agarwal argued for starting even earlier, near 40, because they reach serious disease years sooner and face far higher death risk. "Every year matters," he said. The next signal to watch is the task force's revision.
The American Cancer Society has dropped its hedging on prostate cancer screening. In an update published Thursday in CA: A Cancer Journal for Clinicians, the organization now directly recommends a PSA blood test every two years starting at age 50 for men at average risk. For Black men and for men with a strong family history, it recommends annual screening starting at 45.
The change replaces guidance from 2010 that stressed "informed decision-making," which told men to talk with a health care provider about whether to be tested. Dr. William Dahut, the society's chief scientific officer, said the evidence was not clear enough then to say the benefits outweighed the harms. Since then, he said, two things have changed: steps have been taken to reduce the harms of screening, and long-term data, primarily from European studies, show lower prostate cancer mortality among men screened every two years. Once a man reaches 70, Dahut said, he returns to individual decision-making. The guideline defines an abnormal PSA as 3 nanograms per milliliter or higher for men 69 and younger, and 6.5 ng/mL or higher for men 70 to 74.
The urgency comes from the trend in diagnoses. Prostate cancer is the second-leading cause of cancer death among US men, behind only lung cancer. The rate of diagnosis rose about 3% a year from 2014 through 2022, with more late-stage cancers over that period. The society estimates about 1 in 8 men will be diagnosed in their lifetime, and Dr. Yaw Nyame of the Fred Hutchinson Cancer Center, who served on the expert panel behind the update, said more than 330,000 people in the US will be diagnosed this year. When the cancer is found before it spreads, more than 99% of patients survive at least five years. A European study published last year in the New England Journal of Medicine found that men invited to repeated PSA testing were 13% less likely to die of the disease than those who were not.
The test is not flawless. Nyame noted a high false-positive rate: most abnormal results come from an enlarged prostate, not cancer. Screening can bring unnecessary testing, anxiety and unneeded treatment. That history explains the earlier caution. In 2012 the US Preventive Services Task Force advised against PSA screening, citing overdiagnosis and overtreatment of low-risk cancers that would never have threatened a patient's life. Screening fell afterward, and Nyame said he and colleagues now see more aggressive cancers and men arriving with very high PSAs. The task force moved to a shared decision-making stance in 2018 after European trial data. Since then, Dr. Neeraj Agarwal of Dana-Farber said, MRI, biomarker and genomic tests let doctors target biopsies and recognize low-risk cancers that can simply be watched.
Nyame also pointed to the value of a first PSA in a man's 40s or 50s as a baseline. If it is under 1 ng/mL, lifetime risk is much lower, which can shape how screening proceeds.
Not everyone is aligned. The task force's 2018 recommendation for men 55 to 69 still calls the decision an individual one and carries a C grade. The Affordable Care Act requires no-cost coverage only for services graded A or B, though the task force's website says an update is under way. Medicare already covers screening for many older Americans, and many states require private insurers to cover PSA tests and digital rectal exams. Agarwal said the real cost problem comes afterward: MRI, biomarker tests and biopsy are often billed as diagnostic care. In a 2024 study in the journal Cancer of privately insured men, more than three-quarters had out-of-pocket costs for follow-up after an abnormal PSA. He expects the biggest change in coverage only if the task force grade or legislation moves.
Dr. Justin Gregg of MD Anderson welcomed the update. He said that although dropping "shared decision making" wording may worry some, the document still says clinicians should review the benefits, limitations and harms before a man starts screening.
Agarwal would go further for Black men, starting near 40, as the Prostate Cancer Foundation and American Urological Association suggest. He said Black men reach clinically significant disease three to nine years earlier than other men, face a lifetime diagnosis risk of 1 in 6, and have a death risk two to four times higher. "Every year matters," he said. The next signal to watch is the task force's pending revision.
Citas Notables
Leaving it to each patient and doctor meant a lot of men were simply never offered the test. A clear recommendation fixes that.— Dr. Neeraj Agarwal, Dana-Farber Cancer Institute
Once you hit age 70, you're back in the individual decision-making process.— Dr. William Dahut, American Cancer Society
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