American Cancer Society recommends routine PSA screening for all men
The American Cancer Society has issued new prostate-cancer screening guidance that recommends routine PSA blood tests for all men, reversing its 2010 position, which stopped short of endorsing universal screening. Men at average risk should be tested every two years from ages 50 to 69. Annual screening should begin at 45 for all Black men, and for non-Black men whose close relative was diagnosed before 65 or who have multiple relatives with the disease. If one close relative was diagnosed at 65 or later, testing should also start at 45 but every two years. Men aged 70 to 74 should decide with their doctor whether to continue, while screening is not recommended from 75 onward.
The ACS says newer evidence indicates that screening saves lives and that improved treatment decisions can reduce the harms of overdiagnosis and overtreatment, including erectile dysfunction and urinary incontinence. Men should first discuss the benefits and risks. If PSA reaches 3 ng/mL or more below age 70, or 6.5 ng/mL or more from age 70, the test should be repeated before further action. Persistently high results should lead to an MRI or validated biomarker test, with biopsy reserved for cases showing strong evidence of cancer. For low-risk cancer, active surveillance should be the initial approach. The ACS estimates that 334,000 US men will be diagnosed in 2026 and 36,320 will die from prostate cancer.
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