Prostate Cancer Screening Rules Tighten for Men Over 50

The American Cancer Society issued new guidelines on Thursday that require regular prostate cancer screening for middle-aged men. This decision reverses the organization's previous advice, which had suggested that men at average risk consult with their doctors to determine if and how often to undergo testing. The update provides a specific schedule for prostate-specific antigen tests, moving away from a general recommendation for shared decision-making.

Men at average risk are now advised to receive a PSA blood test every two years between the ages of 50 and 69. For men classified as high risk, the schedule is more frequent and starts earlier. This group, which includes Black men and those with a strong family history of the disease, should undergo yearly testing beginning at age 45. The society defines a strong family history as having one close relative diagnosed before age 65, or multiple close relatives diagnosed at any age. Men with only one close relative diagnosed after 65 should start at 45 but may test every two years.

Dr. Ash Tewari, a urology specialist at Mount Sinai’s Icahn School of Medicine in New York, stated that the change removes ambiguity for primary care physicians. He noted that doctors often introduce screenings to patients but may not be familiar with the complexities of prostate health. Tewari said the new directive essentially tells doctors to proceed with testing. He expressed hope that the guideline will help keep more men healthy for family gatherings in the coming decade.

The shift in guidelines follows advances in medical knowledge regarding how to detect cancer before it spreads while minimizing overtreatment. Past concerns centered on the detection of slow-growing tumors that did not require immediate intervention. The society notes that new protocols, such as repeating tests to confirm elevated levels or using MRI scans to identify candidates for biopsy, help reduce unnecessary procedures. Monitoring low-risk tumors has also become a standard option rather than immediate aggressive treatment.

Screening is not recommended for men whose health is so poor that they are not expected to live another 10 years. For other men, the guideline advises a conversation with a doctor at age 70 regarding the benefits and risks of continuing tests. The society no longer recommends screening at age 75, though it acknowledges that healthy men in their late 70s may choose to continue. Testing is generally discouraged after age 80.

Prostate cancer remains one of the most common cancers in the United States. The American Cancer Society estimates that more than 333,000 men will be diagnosed with the disease in 2026. Approximately 36,000 men are projected to die from it. The new guidelines aim to balance early detection with the avoidance of overtreatment through a structured approach to blood testing.