The American Cancer Society has updated its prostate cancer screening guidelines for the first time in 16 years, placing greater emphasis on regular screening for middle aged men. The recommendations introduce clearer testing schedules based on age and risk.

Prostate cancer is the most common non skin cancer among men and the second leading cause of cancer death in the US. According to the ACS, around 333, 830 men will be diagnosed this year, while more than 36,000 will die from the disease.

The prostate is a small gland located below the bladder and in front of the rectum. It produces some of the fluid found in semen, but its cells can sometimes mutate or change and begin growing uncontrollably into tumors.

There is no single cause for these cellular changes. Known risk factors include aging, genetics, and family history, while smoking, obesity, and diet may play a role in some cases, although the connection remains unclear.

African American men and men with a family history of prostate cancer face a higher risk of developing the disease. Inherited gene mutations are believed to be a major factor in nearly 10% of prostate cancer cases.

Detection remains one of the central challenges because early prostate cancer does not usually produce obvious signs or symptoms. When symptoms appear, they can include a slow or weak urine stream and the need to urinate more frequently, particularly at night.

Blood in the urine or semen can also be a sign of prostate cancer in some instances. However, these symptoms may be caused by other conditions, making screening especially important for men older than 50.

The ACS last updated its guidelines in 2010, when uncertainty surrounded the potential benefits and harms of prostate cancer screening. Much of that concern involved blood testing based on prostate specific antigen, commonly known as PSA.

At that time, two large studies, one conducted in the US and another in Europe, produced conflicting findings about the benefits of screening. PSA testing also had a high rate of false positive results, sometimes leading people without cancer to undergo invasive biopsies.

Those biopsies could bring potentially lasting side effects, including incontinence. Because of those concerns, the ACS did not recommend a specific screening schedule and instead supported shared decision making between patients and their healthcare providers.

More than a decade of additional research has changed that position. The ACS now says stronger evidence shows screening can reduce the chances of dying from prostate cancer, prompting more detailed recommendations about when and how often testing should occur.

The organization now recommends that men in at risk categories receive a PSA blood test every two years from ages 50 to 69. Men in higher risk groups are advised to begin testing sooner and undergo screening more frequently.

Black men should begin testing at age 45 and continue annually. Men whose fathers, brothers, or sons were diagnosed with prostate cancer before age 65 should follow the same schedule, as should men with more than one first degree relative diagnosed before 65.

Dr. William Dahut, the American Cancer Society’s chief scientific officer, said: “For non-Black men with 1 first-degree relative who was diagnosed after age 65, the guideline recommends screening every 2 years from ages 45 to 69”.

Dahut also said: “The updated guideline also includes a recommendation for secondary testing in most men with an elevated PSA, including an MRI and/or biomarker testing, to help determine whether a prostate biopsy is needed.”

For men between ages 70 and 74, the decision to continue screening should be personal. The guidelines say balancing the benefits and harms of treatment becomes more difficult at those ages.

Prostate cancer is highly survivable when detected early, and the updated guidelines are intended to find cases before the cancer spreads. Awareness remains important, particularly because a 2019 study found that only one in four men older than 50 knew what the prostate does.

That survey focused on the age group most likely to develop prostate cancer and other prostate related conditions. The updated guidelines are published in CA: A Cancer Journal for Clinicians.