As rates of advanced prostate cancer continue a worrisome rise, the American Cancer Society is recommending that most men ages 50 to 69 get screened every other year.
asserted
men → continue → rise
Those at higher risk, including Black men and others with close-family histories of the disease, should get the prostate-specific antigen blood test annually.
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Those → include → test
Men ages 70 to 74 should discuss with healthcare providers whether the PSA test makes sense for them, based on their health and life expectancy, according to the ACS.
uncertain
test → discuss → ACS
The new guidelines, published Thursday in CA: A Cancer Journal for Clinicians, are the latest pendulum swing in screening standards for prostate cancer, which is the second-leading cause of cancer death among men, behind lung cancer.
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which → publish → cancer
Dr. William L. Dahut, chief scientific officer of the ACS, said he hoped the new guidelines “would increase screening for men at average risk and ultimately lead to a decrease of men with metastatic disease or dying from the disease, while mitigating harm.”
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guidelines → say → harm
In the previous ACS guidelines, men ages 40 to 50 were advised to engage with their doctors in “shared decision-making” about PSA testing, as long as they had at least a decade of life expectancy.
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they → advise → expectancy
Repeat testing was based on a PSA-level threshold.
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testing → base → threshold
Now, the ACS much more emphatically recommends that men should get the PSA test every other year after they hit age 50.
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they → recommend → age
Annual screening starting at age 45 is advised for two higher-risk groups:
- Black men, who have higher rates of prostate cancer and are likelier to die from it.
- Men who have fathers or brothers diagnosed under age 65 or who have multiple such relatives diagnosed at any age.
The PSA blood test can help detect signs of prostate cancer earlier, when it’s generally more susceptible to treatment.
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it → start → treatment
There have long been concerns about PSA testing, because it can trigger unnecessary treatment with devastating side effects, and historically, research that it actually improved men’s survival chances was lacking.
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it → trigger → chances
Rising cases of advanced prostate cancer
The new guidelines were influenced in particular by a major randomized study of PSA testing in Europe that now has over two decades of follow-up and found that screening among middle-aged men did, indeed, lower prostate cancer deaths.
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screening → rise → deaths
Given those and other encouraging newer research findings, the authors of the updated ACS guidelines felt they could recommend the test as beneficial with greater confidence and be more specific about which groups should get tested and at what intervals.
uncertain
groups → give → intervals
While the rate of death from prostate cancer fell by half over the past three decades, the decline has slowed overall and stabilized among men ages 55 to 69.
The Food and Drug Administration approved the PSA test for cancer surveillance in 1986.
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Administration → fall → 1986
Following broad use of the test for prostate cancer screening, late-stage prostate cancer diagnoses dropped by more than half and the death rate fell by 7% by the mid-1990s.
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rate → follow → mid-1990s
But in the 2000s, various national health authorities became more concerned about overdiagnosis.
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authorities → become → overdiagnosis
So they narrowed the categories of men for whom they recommended screening.
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they → narrow → whom
In 2012, the highly influential U.S. Preventive Services Task Force flatly recommended against PSA testing for men of any age.
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Force → recommend → age
Diagnoses of late-stage disease subsequently began to creep up, leading to concern that lowered testing was a factor and, ultimately, to campaigns to once again broaden testing.
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testing → begin → testing
An ACS study last year found that diagnoses of prostate cancer increased by about 3% annually from 2014 to 2021.
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diagnoses → find → 2021
Dahut, who was a co-author of the study, said the trend has continued in recent years.
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trend → say → years
The study also found that over a decade of data, cases of metastatic prostate cancer increased by about 6% annually in men ages 55 and older.
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cases → find → men
At its best, PSA testing can identify early-stage prostate cancer and lead to treatment — surgery and radiation is the standard of care — that stops it from spreading, improving men’s survival.
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that → identify → survival
Among men diagnosed with late-stage prostate cancer, only about a third live five more years.
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third → diagnose → cancer
However, the PSA test often identifies cancers that won’t cause major sickness or death, at least not in the near term.
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that → identify → term
In those cases, men would often be better off receiving ongoing monitoring rather than treatment.
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men → receive → monitoring
Many older men die with prostate cancer but not because of it.
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men → die → it
That’s a key reason the ACS and other health authorities don’t recommend the test for older men or others who most likely won’t live 10 more years.
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who → ’ → men
PSA testing can also produce false positives that lead to unnecessary treatment and anxiety.
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that → produce → treatment
And the biopsy needed to diagnose prostate cancer comes with health risks.
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biopsy → need → risks
Crucially, surgery and treatment for prostate cancer can cause severe impacts, including sexual dysfunction, urinary incontinence and bowel problems.
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surgery → cause → dysfunction
According to Dahut, recent improvements in medical practices have helped mitigate those effects.
uncertain
improvements → accord → effects
The previous ACS guidelines, issued in 2010, advised doctors to discuss with middle-aged men and younger seniors whether they’d like to take the PSA test.
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they → issue → test
That more flexible dynamic left too many men forgoing the screening, ACS experts felt.
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experts → leave → screening
The new guidelines urge doctors to more flatly recommend the test to that age group.
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guidelines → urge → group
Promisingly, doctors are better able to differentiate between prostate cancer cases that are serious enough to need immediate treatment and those that are better monitored over time.
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that → differentiate → time
“Cancer still prompts a visceral, negative reaction in most people that for the most part is unwarranted in a lot of circumstances,” said Dr. Daniel George, a medical oncologist at Duke Health who specializes in urological cancers.
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who → prompt → cancers
George wasn’t involved with the new guidelines.
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George → involve → guidelines
“There are more cancer survivors in the United States than ever before in history,” he said.
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he → be → history
“That’s only going to increase.
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That → go → ?
And that’s not because of overdiagnosis; that’s because of more effective therapies for these patients.”
The change in guidelines could, in theory, have caught former President Joe Biden’s cancer earlier.
uncertain
change → ’ → cancer
…and 8 more, not listed.
The Aporia
