A University of Colorado Anschutz Cancer Center expert in prostate cancer says he and his colleagues are “extremely excited” about the first update to prostate cancer screening guidelines from the American Cancer Society (ACS) in 16 years – guidelines that he says help clarify when and how men should be checked.
“What the guidelines have to say about PSA tests, about MRIs, and about active surveillance of low-risk cancers is fantastic,” says David Strauss, MD, a urologist who is an assistant professor in the CU Anschutz Department of Surgery’s Division of Urology.
Prostate cancer is the most common cancer among men in the United States other than skin cancer and the second most common cause of cancer deaths in men, the ACS says.
The revised guidelines for clinicians, published Thursday by the ACS, say that men at average risk of prostate cancer should get a simple blood test known as a PSA test every two years between the ages of 50 and 69. The organization’s previous guidance said men should decide with their doctor whether and how often to get screened.
The latest ACS guidance also recommends annual PSA screening between ages 45 and 69 for men considered at higher risk of prostate cancer. That includes Black men and men with a “strong family history” of the cancer, such as those with multiple first-degree relatives – parents, siblings, and children – diagnosed with prostate cancer at any age or one close relative diagnosed before age 65.
But the new recommendations also say there still needs to be a provider-patient conversation about potential benefits, limitations, and harms before testing.
The updated guidelines say most men with an abnormal PSA reading confirmed by a repeat test should be offered further evaluation in the form of magnetic resonance imaging (MRI) of the prostate or a validated biomarker test of blood or urine for genes, proteins, or other molecular signatures that can signal “clinically significant” cancers that could endanger the patient. Those tests should guide whether a biopsy of prostate tissue is needed, they say.
In men, the prostate is a walnut-sized gland at the base of the bladder and adjacent to the rectum. It surrounds the urethra, the tube that carries urine from the bladder to the penis. It makes seminal fluid that mixes with sperm produced by the testicles, and it contains muscles that help push semen through the urethra during an orgasm.
We turned to Strauss – whose clinical and research interests include prostate cancer surveillance and therapy – to help us better understand the new guidelines and what they mean for men.