Prostate Cancer Screening Guidelines Updated

The American Cancer Society has updated its prostate cancer screening guidelines to recommend prostate-specific antigen (PSA) screening every two years for average-risk men ages 50-69 and annual screening starting at age 45 for Black men and men with significant family history of the disease.

The new recommendations are the first update to the guidelines since 2010 and were assembled by a team of top cancer experts, including UVA Health’s Andrew Wolf, MD, a leading researcher in early cancer detection. 

“For the first time, we are making a proactive recommendation for men to screen for prostate cancer with the prostate-specific antigen blood test,” said Wolf, professor emeritus of medicine at the University of Virginia School of Medicine and chair of the American Cancer Society’s Guideline Development Group. “It’s now clear that the benefits of screening in terms of reducing the risk of dying from prostate cancer or being diagnosed with late-stage disease outweigh the potential downsides of the screening.”

Prostate cancer is the most commonly diagnosed cancer and second-leading cause of cancer deaths among men in the United States, killing more than 36,000 each year. Death rates are roughly twice as high in Black men as in white men.

The ACS guidelines previously recommended that men consult with their doctors on whether they should receive PSA screening, which consists of a simple blood test. But in the years since the guidelines were last updated, there has been growing evidence that screening is highly effective both at saving lives and detecting advanced forms of the disease. 

“PSA testing remains the cornerstone of detecting prostate cancer early, and we now have stronger evidence of its benefits,” said the new guidelines’ senior author, Robert Smith, PhD, senior vice president of early cancer detection science and director of the Center for Early Cancer Detection at the ACS. “We also have better approaches to catching lethal tumors while avoiding unnecessary tests for slow-growing cancers that may never need aggressive care. The PSA test is just the first step in a screening process. Secondary testing for men with elevated PSA levels determines who needs a biopsy … and, if so, who needs immediate treatment and who can be safely monitored via active surveillance.”

Other screening recommendations include:

• Doctors should take an individualized approach to helping men ages 70 to 74 determine if they should continue screening, basing the decision on potential risks and rewards. (Because prostate cancer tends to grow very slowly, patients at this age may want to discontinue screening to avoid the chances of a false positive, the need for a biopsy, etc.)
• Screening is not recommended for men ages 75 or older. Some healthy men who are 75 to 79 may want to continue screening, especially if their PSA has been rising. But they should discuss this with their doctor.
• Screening is not recommended for men 80 or older, or for men not expected to live another 10 years.

For men with elevated PSA levels or confirmed prostate cancer: 

• Men with elevated PSA between ages 45 and 74 should undergo repeat PSA testing between two weeks and three months after their initial test.
• Elevated PSA should be confirmed by magnetic resonance imaging (MRI) and/or testing with a urine or blood biomarker (biological indicator) to determine if a biopsy is needed.
• Men diagnosed with prostate cancer that has a low risk of growing or spreading should be offered “active surveillance” – close monitoring – as the first treatment option, rather than a more aggressive tactic.

“If men and their healthcare providers follow these recommendations, I’m very confident that we’ll see a decline in prostate cancer deaths and metastatic disease over the coming years,” Wolf said. “I urge men to talk with their health care providers to learn more about the benefits, limitations and downsides of screening, and to get screened.” 

Wolf and colleagues at UVA Comprehensive Cancer Center work diligently to improve cancer detection, develop better cancer treatments and, ultimately, save lives. UVA’s cancer center is one of only 58 in the country to earn the elite “comprehensive” designation from the National Cancer Institute in recognition of their exceptional patient care and cutting-edge cancer research.

The cancer center’s efforts align with the mission of UVA’s new Paul and Diane Manning Institute of Biotechnology to accelerate the development of new drugs and cures based on UVA’s cutting-edge science, to benefit patients across Virginia and around the world. 

Guidelines Published

The new prostate cancer guidelines have been published in CA: A Cancer Journal for Clinicians. The article is open access, meaning it is free to read. The guidelines were assembled by Richard M. Hoffman, Wolf, Ruth D. Etzioni, Kevin C. Oeffinger, Sana Raoof, Louise C. Walter, Charnita Zeigler-Johnson, Timothy R. Church, Christopher K. Jones, Artie L. Shelton, Elena B. Elkin, Carmen E. Guerra, Rebecca B. Perkins, Ya-Chen Tina Shih, Steven J. Skates, Roman Gulati, Hormuzd A. Katki, Tyler B. Kratzer, Deana Manassaram-Baptiste, William L. Dahut and Smith.