CHARLOTTSVILLE, VA (CVILLE RIGHT NOW) – A UVA Health internal medicine specialist chaired an American Cancer Society group this week that updated the prostate cancer screening guidelines that positively recommend screening through the PSA-based test every two years for average-risk men ages 50-through-69, with some different parameters for men at greater risk.

“ACS recommends annual PSA-based screening beginning at 45 years old for Black men and men with a strong family history of prostate cancer,” according to a release from the working group chaired by Andrew Wolf, MD, and Professor of Internal Medicine at the University of Virginia School of Medicine.

“Up until now, we’ve been recommending what we call shared decision making, that men have a discussion with their doctors to decide if prostate cancer screening is right for them,” Wolf said in a Friday morning UVA Health media call. “But what’s happened now is that it’s quite clear that the benefits of screening, in terms of reducing the risk of dying from prostate cancer and the risks of being diagnosed with metastatic disease, late-stage disease, are significantly lowered by regular screenings of PSA blood tests.”

The issue over the years has been elevated antigens found in the testing led to treating low-grade, slow-growing cancers being treated with radiation and other techniques used to treat high-risk cancer, according to Dr. Wolf.

“What we’re now finding is those cancers don’t need to be treated, at least not right away,” Wolf said. “They need to be monitored, because those are the cancers that aren’t destined to go ahead and kill people.”

There are now different diagnostic and treatment approaches developed over time for men with elevated antigens.

“We now do MRI routinely of the prostate for men who have an elevated PSA level, and some of those MRIs are normal,” he said. “Those were false alarms. Those PSAs were abnormally high, but they weren’t due to cancer. They were just due to having large prostates or other reasons.”

“Doing an MRI helps to reduce the number of unnecessary biopsies, and if a suspicious lesion is found on a prostate MRI, those lesions can be targeted with biopsy, and we’re more likely to find clinically significant cancers that want treatment,” said Wolf.

Doctors are now avoiding the harms of radiation and other treatments being administered to patients who really don’t need it while being able to focus more on those who do.

Wolf said the data is incomplete as to why Black men are at risk at a younger age.

“We do believe it’s a complex interplay between perhaps biological factors, but also environmental, dietary factors, and likely structural inequities in our healthcare system,” he said. “Certainly, that explains why Black men are about twice as likely to die from prostate cancer, and are also diagnosed at later stages of disease.

“But it’s clear that, Black men do… are at higher risk for developing prostate cancer at younger ages and their prostate cancers are at higher risk for progressing more rapidly than non-Black men,” he said.

The PSA-based test recommendation ups the guideline that was “shared decision making” between the doctor and patient. That standard, in the new guidelines, is still recommended for men 70-to-74.

“It’s really partly because the evidence is less clear for men aged 70 to 74. We just don’t have the same body of evidence that we have for young men, and that’s part of it,” Wolf said. “Another issue is, as men get older, they are more likely to have life-limiting diseases, and prostate cancer, by and large, on average, is a longer-term cancer, and so men have to have a longer life horizon to see the benefits of screening.”

“Prostate cancer is one of the most common cancers in men and is the second leading cause of cancer death in men in the United States,” according to the American Cancer Society. “An estimated 333,830 men will be diagnosed with prostate cancer in 2026, with an estimated 36,320 men dying of the disease. Incidence and mortality rates display substantial disparities across racial and socioeconomic groups.”