By Shellie M. Scott
The American Cancer Society is recommending that Black men get a prostate cancer screening blood test every year from age 45 through 69. The updated guideline, released Nov. 12, aims to catch more cancers before they spread and reduce a persistent racial disparity. Black men in the United States are diagnosed with prostate cancer at a rate 67% higher than White men and die from it at roughly twice the rate, according to the cancer society.
Age 45 was already a milestone in the cancer society’s guidance. Under its previous recommendations, Black men were advised to begin discussing screening with a health care provider at that age. The new guideline gives patients and clinicians a specific testing schedule. It also recommends annual screening from 45 through 69 for men with a strong family history of prostate cancer. For men at average risk, the recommendation is every two years from ages 50 through 69.
What the blood test can tell you
The test measures prostate-specific antigen, or PSA, a protein made by the prostate. A higher PSA level can signal cancer, and it can also result from a noncancerous condition such as an enlarged prostate. Screening is meant to look for signs of disease in people who feel well, so a man can be due for testing even if he has no symptoms.
An elevated result usually starts with a repeat blood test. If the level stays high, the cancer society recommends offering an MRI or a validated biomarker test, or both, to help determine whether a biopsy is warranted. That step matters because screening can uncover slow-growing cancers that may never cause health problems. For men diagnosed with low-risk prostate cancer, the society recommends offering active surveillance first. That approach uses regular follow-up to watch for changes that may call for treatment.
The cancer society says the evidence that PSA screening can reduce deaths and advanced diagnoses has strengthened since its last update in 2010. It also points to advances in follow-up care that can help clinicians avoid some unnecessary biopsies and treatments. The guideline calls for clinicians to explain those benefits and potential harms before testing begins, so patients know what an abnormal result could mean and what decisions might follow.
Closing the gap takes more than a blood test
For Black men turning 45, the update gives them a specific question to bring to a primary care visit: “Should I start yearly PSA testing now?” Men already in the recommended age range can ask when they were last tested and how they will receive their results. If a father, brother or son had prostate cancer, knowing his age at diagnosis can help make that conversation more informative.
For health systems serving Black communities, the recommendation also puts attention on what happens after the appointment. A patient with an elevated PSA needs to know when to return for another blood draw and how to get further testing if the result stays high. Whether earlier screening helps narrow the death-rate gap will depend in part on whether men can get that follow-up and reach treatment when they need it.
