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Middle-aged men should undergo regular screening for prostate cancer, the American Cancer Society said Thursday in a major change to U.S. guidelines.
The screening involves a simple blood test, and men at average risk of getting prostate cancer should get that PSA test every two years between the ages of 50 and 69, the society advised.
Men at high risk, including Black men and those with a strong family history of prostate cancer, should get yearly PSA checks and start earlier, at age 45, it said.
Thursday’s guideline update marks a shift in thinking in the U.S. about routine blood tests for PSA, or prostate-specific antigen.
Since 2010, the American Cancer Society has recommended that men at average risk talk with their doctors about whether to get regular PSA tests.
The tests look for a protein produced by both normal and cancerous prostate cells, meaning a high level might signal a tumour, but also could be from a benign enlarged prostate or be a temporary spike from vigorous exercise.
Widespread PSA testing in the past was blamed for overtreatment of slow-growing tumours and unnecessary followup testing in men who turned out to not have cancer.
The updated advice in the U.S. comes after advances in understanding PSA’s benefits and how to reduce potential harms, according to the cancer society. This includes steps such as repeating a PSA test to be sure it’s really high or adding an MRI scan to help identify who needs a biopsy.
Canadian guidelines need update, experts say
In Canada, guidelines for prostate cancer screening vary by province and organization, but official guidelines for clinicians from Canada’s national advisory body haven’t been updated since 2014 — something the Canadian Cancer Society has flagged as a serious issue.
A survivor is marking Prostate Cancer Awareness Month by urging others to get screening and seek support. The Cancer Foundation of Saskatchewan says at least two men on average are diagnosed with prostate cancer every day in Saskatchewan.
The national body that historically issued cancer screening guidelines was the Canadian Task Force on Preventive Health Care. But after years of criticism that it was too slow to update guidelines, it was overhauled and replaced with the National Advisory Committee on Preventive Health Services this summer.
The 2014 guidelines don’t recommend the use of PSA tests for prostate cancer screening, citing a concern for false positives and unnecessary biopsies.
The Canadian Cancer Society — which advises on its website that men should talk to their health-care providers and consider screening with PSA tests starting at age 45 for those of high risk, and age 50 for those of average risk — issued an open letter to the new advisory body in September, urging them to update guidelines.
“What we have now is a guideline that is frozen in time from over a decade ago, and increasingly out of step with contemporary clinical practice,” the open letter states. “In Ontario and British Columbia, the outdated guidance continues to be cited as a reason for denying public coverage of PSA testing for asymptomatic men who have received a referral from their physician.”
New research suggests that cases of stage 4 prostate cancer have gone up since Canada changed guidelines for a screening blood test, known as PSA, but experts disagree about whether screening guidelines should change.
How long should men continue screening?
The new U.S. guidelines say that starting at 70, men should talk with their doctors about whether it’s beneficial to continue the routine PSA checks. But it discourages screening for men 80 and older, as well as for those of any age who aren’t expected to live another 10 years because of other health problems.
This 1974 microscope image made available by the Centers for Disease Control and Prevention shows changes in cells indicative of adenocarcinoma of the prostate. (Dr. Edwin P. Ewing, Jr./CDC via The Associated Press)
Prostate cancer is one of the most common cancers in men. The American Cancer Society estimates more than 333,000 men in the U.S. will be diagnosed with prostate cancer in 2026, and about 36,000 will die of it.
In Canada, prostate cancer is the second leading cause of death from cancer for men, according to the Canadian Cancer Society. The society estimates 29,300 men in Canada will be diagnosed with prostate cancer in 2026, and 5,300 will die of it.
