The American Cancer Society is directly urging men to undergo prostate cancer screening, replacing its previous emphasis on informed decision making with a clearer recommendation. The updated guideline was published Thursday in CA: A Cancer Journal for Clinicians.

Men at average risk should receive PSA based screening every two years from ages 50 through 69. Annual screening should begin at 45 for Black men and men with a strong family history of prostate cancer.

For high risk men, that family history includes a first degree relative diagnosed before age 65 or multiple first degree relatives diagnosed at any age. After men reach 70, decisions about screening should again be made individually.

The previous guideline, published in 2010, encouraged men to discuss screening with a health care provider rather than explicitly recommending it. At that time, the balance between the benefits and potential harms of screening was less clear.

The society says evidence now shows that PSA screening significantly reduces the risk of dying from prostate cancer. Long term European data found that men screened every two years experienced lower prostate cancer mortality, while medical advances have helped reduce screening related harms.

A PSA test measures prostate specific antigen, a protein produced by the prostate gland, in a blood sample. Elevated levels can be caused by prostate cancer, but they may also reflect an enlarged prostate or, less commonly, an infection.

Under the updated guideline, an abnormal PSA level is 3 nanograms per milliliter or higher for men 69 and younger. For men ages 70 to 74, the threshold is 6.5 ng/mL or higher.

An initial PSA result obtained in a man’s 40s or 50s can establish a useful baseline. Dr. Yaw Nyame of the Fred Hutchinson Cancer Center said a first result below 1 ng/ml is associated with a much lower lifetime risk of prostate cancer.

The renewed push comes as diagnoses rise. Prostate cancer is the second leading cause of cancer death among men in the United States, while the diagnosis rate increased about 3% annually from 2014 through 2022 and more late stage cancers were found.

About 1 in 8 men will be diagnosed with prostate cancer during their lifetime, according to the American Cancer Society. More than 330,000 people in the United States are expected to receive a diagnosis this year.

Early detection can sharply improve the outlook. When prostate cancer is found before it spreads, more than 99% of patients survive for at least another five years, and many people whose cancers are detected early can be cured after treatment.

A European study published last year in the New England Journal of Medicine found that men offered repeated PSA testing were 13% less likely to die from prostate cancer than men who were not invited for screening. Still, PSA testing can produce false positive results and lead to anxiety or unnecessary procedures.

Doctors now have MRI, biomarker and genomic tests that can help identify which patients face the greatest cancer risk after an elevated PSA result. Many low risk cancers can also be monitored instead of immediately treated with surgery or radiation.

Federal guidance remains different from the American Cancer Society’s approach. The US Preventive Services Task Force recommends individual decisions for men ages 55 to 69, and its 2018 prostate cancer screening recommendation has a C grade, although an update is underway.

Medicare covers prostate cancer screening, and many private plans also cover the PSA blood test. However, patients may face deductibles and coinsurance for MRI scans, biomarker testing or biopsies after an abnormal result, with one study finding such costs among more than three quarters of privately insured men receiving follow up testing.

Black men face especially serious risks. Their lifetime likelihood of a prostate cancer diagnosis is 1 in 6, their risk of death is two to four times higher than for other men, and clinically significant disease may appear three to nine years earlier.

The guideline recommends repeating an abnormal PSA test, preferably two weeks to three months after the first test, before further evaluation. Supporters say the clearer recommendation could simplify clinical decisions, strengthen the case for broader coverage and help more men receive potentially lifesaving screening.