Prostate cancer screening recommended every 2 years for men starting at age 50

All men should begin PSA screening for prostate cancer every two years at age 50, with Black men — and others at higher risk — starting at 45 and continuing annually, according to updated guidelines released Thursday by the American Cancer Society.

Additionally, men with confirmed elevated prostate-specific antigen levels should undergo an MRI or another test to determine if their cancer is "clinically significant" before undergoing a biopsy.

Previously, the American Ca ncer Society did not make a direct recommendation for regular PSA screening, because it was concerned that elevated levels could lead to repeated biopsies and unnecessary surgeries. The group's last guidelines were released in 2010.

"Twenty-five years ago, if you had prostate cancer, you got treated whether it was radiation or surgery," said Dr. Manish Vira, system chief of urology at the Northwell Cancer Institute in Lake Success. "Our diagnostic evaluation has improved dramatically with the use of MRI. We are much more cognizant of not overtreating patients who have low-risk disease."

Robert Smith, director of the Center for Early Cancer Detection at the American Cancer Society and senior author of the report, said in a statement that there are now "better approaches to catching lethal tumors while avoiding unnecessary tests for slow-growing cancers that may never need aggressive care."

Prostate cancer is the most common cancer among men in the United States after nonmelanoma skin cancer, according to the Centers for Disease Control and Prevention.

Men may have no symptoms during the early stages of the disease. Those who have trouble with urination, blood in their urine, or pains in their back, hips or pelvis are advised to see their doctors because these symptoms could signal an enlarged prostate or prostate cancer.

The National Cancer Institute estimates 333,830 new cases of prostate cancer will be diagnosed in 2026 and 36,320 men will die of the disease. About 98% of prostate cancer patients live for at least five years after their diagnosis, depending on the stage of cancer.

Black men have a higher incidence of prostate cancer and almost double the mortality rate when compared with white men, said Dr. William Dahut, chief scientific officer at the American Cancer Society.

Specifically, the updated guidelines advise a PSA screening every two years for men 50 to 69 with an average risk of developing prostate cancer.

Men at higher risk, which includes Black men and all men with parents or siblings diagnosed with prostate cancer before the age of 65, should get screened every year while between the ages of 45 and 69.

The PSA blood test looks at the level of prostate-specific antigen, a protein. A higher level may signal prostate cancer, and the level can vary depending on the patient's age. The American Cancer Society recommends men 69 years of age or younger with levels of 3 ng/mL or higher be retested before taking other actions.

"This almost codifies how our field's changed since they put out their last set of guidelines," said Dr. Jeffrey Schiff, director of minimally invasive urology at NYU Langone Hospital—Long Island in Mineola. "Things are evolving in a good way for patients."

Screening and ongoing surveillance can be done with repeated PSA tests and MRIs, which use magnetic fields and radio waves to take photos inside a person's body without using ionizing radiation.

"Surveillance in the past could be annual biopsies," Schiff said, which can cause physical discomfort as well as psychological stress to the patient.

Those annual biopsies were often "blind," while the MRI provides detailed information such as the volume of the prostate and any suspicious changes, Vira said.

"Men would get biopsies for years in a row, and they wouldn't find the cancer because it was in a spot where you didn't biopsy it," Vira said. "Those days are gone now. ... Our ability to try to predict which patients will have a cancer that may cause them harm in the future, and therefore would benefit from treatment today, is getting better and better."

By Lisa L. Colangelo

lisa.colangelo@newsday.com@lisalcolangelo

Lisa joined Newsday as a staff writer in 2019. She previously worked at amNewYork, the New York Daily News and the Asbury Park Press covering politics, government and general assignment.