Prostate cancer screening guidelines upgraded as more men are urged to get checked every other year… amid rising cases

Leading cancer authorities have expanded prostate cancer guidelines amid a surge in cases.

The American Cancer Society (ACS) announced Thursday that it was now recommending all men ages 50 to 69 undergo prostate cancer screening every two years.

It also urged black men and those with a family history of the disease to start annual screening at age 45.

Previously, the ACS did not recommend routine screening for men of any age, instead suggesting patients discuss potential risks and benefits with their doctors.

They said all screenings should be done using a blood test for prostate-specific antigens (PSA), which can detect prostate cancer. Some studies suggest it is accurate in 70 to 80 percent of cases, but others have suggested the test is much less reliable.

Prostate cancer is when cells in the prostate, a gland below the bladder that adds fluids to semen, start to divide uncontrollably. 

It is the most common cancer in men, striking 333,000 and killing about 36,000 every year. It’s also the second-leading cause of cancer death among men, behind only lung cancer. 

Most cases, about 60 percent, are diagnosed in men over 65, with the average age being 68 years. 

Those who have a family history of the disease or are from a black ethnic background are at higher risk of developing the condition.

Figures warn cases of the cancer are rising by about five to six percent every year, especially in men under 40. 

Dr William Dahut, ACS’ chief scientific officer, said: ‘Previously, the American Cancer Society did not recommend a specific prostate cancer screening schedule. Instead, it recommended that men make a shared decision with their doctor about whether to be screened.

‘But we thought it was important to update our prostate cancer guideline because we now have stronger evidence that screening can lower a person’s chance of dying from prostate cancer.’

Dahut also notes that men ‘diagnosed with prostate cancer have better treatment options and higher survival rates when the disease is caught early.’

The new guidelines also suggest that men ages 70 to 74 should use ‘individualized decision-making,’ as it’s unclear if the benefits of screening outweigh potential risks in older men. Men over 75 are not recommended to be screened.

ACS guidelines do not automatically become standard medical practice and are meant to be advisory, meaning individual doctors and insurance companies may not cover the screenings for patients. 

Insurance coverage highly depends on age, overall risk level and the company. Typically, private plans cover prostate cancer screenings after age 50 or after age 40 in higher-risk groups, such as black men and those with family history.

Patients can order a PSA test through their primary care provider or an independent lab if they are in the recommended age or risk windows, or if they have symptoms such as trouble urinating, sudden urges to urinate or pain during ejaculation.  

When prostate cancer is diagnosed in early stages, the five-year survival rate is more than 99 percent, ACS says. But when it spreads to other organs, like the liver or lungs, that survival rate drops to 38 percent.

Standard treatments include surgery, radiation and chemotherapy. 

How the cancer is treated depends on the individual’s case, their age and how fast the cancer is growing. 

In older men who are diagnosed with prostate cancer that is slow growing, doctors may not recommend surgery or chemotherapy for the disease – which can also cause complications such as incontinence and erectile dysfunction.

The new recommendations come as prostate cancer cases surge across the US. ACS research published this week alongside the updated recommendations found that while rates declined by about 6.4 percent per year between 2007 and 2014, there has been an uptick of roughly three percent annually since 2014.

The review found that early-stage prostate cancer diagnoses increased by about 4.6 percent annually since 2013, while late-stage diagnoses increased 5.6 percent per year since 2011.  

Separate data from Becker’s Oncology found that new prostate cancer diagnoses among younger men, ages 35 to 44, increased 22.8 percent between 2021 and 2024, although the cancer still remains relatively rare in those groups.

Experts believe that while much of the surge is likely due to increased screening, as well as family history and inherited gene mutations, recent studies are also honing in on environmental exposures, such as pesticides, antibiotic use and the gut microbiome. 

Black men are advised to undergo more regular screening because they are 67 percent more likely to be diagnosed with prostate cancer and have twice the mortality rate of white men, Dahut says.

He also added that they are more likely to be diagnosed at younger ages and with more aggressive disease. This is because men of African or Caribbean ancestry have a higher genetic predisposition for the disease and are more likely to face healthcare disparities such as a lack of access to care.

A PSA test measures the amount of prostate-specific antigen, a protein produced by prostate cells, in the blood. Normal PSA levels for men ages 40 to 49 are between 0 and 2.5ng/ml (nanograms per milliliter), while men ages 50 to 59 should have a level between 2.5 and 3.5ng/ml. 

Men ages 60 to 69 should have a PSA of 2.5 to 4.5ng/ml, while those over age 70 should range from 4.5 to 6.5ng/ml.

PSA levels tend to naturally increase with age as the prostate grows. 

‘First, it’s important to remember that an elevated PSA level does not mean you have prostate cancer,’ Dahut said. ‘PSA levels can fluctuate, so the guideline recommends repeating the test within two weeks to three months to confirm the result.’

A biopsy is ultimately needed to detect prostate cancer.

Early-stage prostate cancer rarely causes symptoms, but as the disease develops, men may experience difficulty urinating, frequent urination or a sudden urge to urinate, pain during urination, blood in the urine, painful ejaculation or erectile dysfunction.