The American Cancer Society released prostate screening guidelines Thursday, its first update since 2010. The old advice left the PSA blood test up to each man and his doctor. Now it recommends a PSA test every two years for average-risk men aged 50 to 69. Black men and men with a strong family history should get tested every year from 45. If a high result is confirmed, doctors should offer an MRI, a biomarker test or both, to help decide whether a man needs a biopsy. For low-risk cancers, doctors should offer close monitoring first. The society doesn't recommend screening from 75, though very healthy men under 80 can keep going after talking with a doctor. University of Minnesota urologist Dr. Philipp Dahm called the change "truly a reversal." The federal Preventive Services Task Force still calls it an individual choice for men 55 to 69.

A Clear Recommendation Will Save Lives

The society and many cancer doctors say leaving it up to each man meant too many never got tested.

Too many men never got the test. Dr. Neeraj Agarwal, co-director of the Prostate Cancer Program at Dana-Farber/Harvard Cancer Center, said men "were simply never offered the test." He added, "A clear recommendation fixes that." In 2023, fewer than 40% of men aged 55 to 69 got a PSA test, The New York Times reported. Robert Smith, the society's senior vice president for early cancer detection science, told Healio that shared decision-making "commonly has not occurred. When it has occurred, it has not been done well."

The newest trial data shows screening saves lives. Smith cited a European trial that followed men for 23 years. Regular screening cut the risk of dying from prostate cancer by 13%, about two deaths prevented per 1,000 men screened. "We felt it was important to be clear that prostate cancer screening does save lives," Smith told The Times. Dr. William Dahut, the society's chief scientific officer, told CNN that prostate cancer diagnoses have risen over the last decade, "driven primarily by men who have advanced prostate cancer."

Survivor numbers are rising because treatment got better. Dr. Daniel George, a Duke Health cancer doctor, told NBC that the rise is "not because of overdiagnosis," but "because of more effective therapies."

The new MRI and biomarker steps should cut needless biopsies. Dr. James Eastham, chief of urology at Memorial Sloan Kettering, called the guidelines "a balanced approach." He told STAT that many men have had "unnecessary biopsies," and that the new steps between a high PSA and a biopsy address that.

Doctors still have to explain the harms first. Dr. Justin Gregg, an MD Anderson urologist who backs the change, told CNN that dropping "shared decision making" may "concern some." He said the guideline still tells doctors to explain the harms before a man starts screening.

Doctors Will Just Test Everyone, and the Harms Are Real

Skeptics say a blanket call to test will lead to more biopsies and treatment that many men don't need.

Doctors will read this as "test everyone." Dr. Alex Krist is a Virginia Commonwealth University family medicine professor who helped write the 2018 federal task force guideline. "The way that'll be operationalized by most physicians is they're just going to get this test on everyone," he told The Times. "It's a lot of harms still. And I'm not sure it's going to have the benefits they're predicting."

Many men get treated for cancers that would never hurt them. The task force estimated that for every 1,000 men offered screening, 100 would get a prostate cancer diagnosis. Up to half of those cancers would never cause harm. It said most of those men would get treated anyway. And 65 men would end up with erectile dysfunction or incontinence. The American Academy of Family Physicians doesn't recommend PSA screening at all.

Black Men Need Earlier Tests, or Better Care

Some doctors say Black men should start even earlier, and others say the bigger gap is in care.

Black men should start closer to 40. The society says Black men get prostate cancer at a 67% higher rate than white men and die of it at nearly double the rate. Agarwal told CNN they should start screening closer to 40, not 45. "Every year matters, and if you delay the screening, we know that you lose the window of opportunity to diagnose the patients with curable disease," he said.

Black men's worse outcomes come mainly from unequal care. Dr. Otis Brawley, a Johns Hopkins oncologist who studies cancer disparities, told The Times he understood the push to start earlier. But he said he didn't know of data showing the cancer is more aggressive in Black men. He said Black men have worse outcomes mainly because they get less access to high-quality care. The Times notes research showing that Black men who get the same care in the same hospitals as white men have the same outcomes.

Men Often Pay for the Tests That Come After a High PSA

The blood test is usually covered, but the follow-up scans and biopsies often come with deductibles and coinsurance.

Patients can get billed for the follow-up. "The PSA blood test itself is generally covered," Agarwal told CNN. "The real problem is what comes next." He said MRIs, biomarker tests and biopsies are often billed as diagnostic care, so patients can face deductibles. In one large study, more than three-quarters of privately insured men paid out of pocket for follow-up tests. Lisa Lacasse, president of the society's advocacy arm, said out-of-pocket costs "can be a significant hurdle."

Coverage rules usually follow the federal task force. Agarwal said coverage mandates usually follow the task force's grade or new legislation. Dahut said private insurers often follow Medicare, "but they're not mandated to do that." The task force hasn't finished its own update yet.

Where This Lands

Smith and Agarwal say too many men never got tested, and a clear call to screen will save lives. Krist says most doctors will just test everyone, and the harms remain. The family doctors' group still doesn't recommend PSA screening at all. Agarwal wants Black men tested starting closer to 40, while Brawley says the bigger problem is unequal care. Agarwal says coverage mandates usually follow the task force or new laws. That task force is still working on its update.

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