The American Cancer Society on Thursday released an updated prostate cancer screening guideline that, for the first time, directly recommends regular PSA-based testing rather than leaving the decision mainly to a shared conversation with a doctor, the society announced.
Average-risk men should get a prostate-specific antigen blood test every two years from ages 50 through 69, the ACS said, with clinicians making sure patients understand the potential benefits, limitations and harms before they start. Black men, and men with a strong family history of prostate cancer, should begin annual PSA screening at 45 and continue through 69. The guideline is published in CA: A Cancer Journal for Clinicians.
The previous ACS guideline, published in 2010, did not include a direct recommendation for regular screening. The change, the society said, reflects stronger evidence that PSA testing reduces deaths and diagnoses of advanced disease, plus better ways to manage elevated results so fewer men face unnecessary biopsies and treatment. "PSA testing remains the cornerstone of detecting prostate cancer early, and we now have stronger evidence of its benefits," said Dr. Robert Smith, the ACS's senior vice president for early cancer detection science and senior author of the report.
Who should start earlier, and when to stop
The ACS patient guidance spells out the family-history split. Non-Black men with a close relative (father, brother or son) diagnosed before age 65, or with more than one such relative at any age, should be screened every year from 45 to 69. If only one close relative was diagnosed at 65 or older, the interval is every two years, still starting at 45. Men with inherited gene changes such as a BRCA2 mutation, or a close relative with a linked mutation, should talk with a clinician about when to start.
At ages 70 to 74, the balance of benefits and harms is less clear; men should discuss whether to continue, and if they do, testing should be every two years. ACS does not recommend screening at 75 and older, though some very healthy men 75 to 79 may want to continue, especially if their PSA has been rising, after talking with a doctor. Screening is discouraged after 80 under all circumstances, and at any age if someone is in poor health and not expected to live at least 10 years. ACS does not recommend the digital rectal exam as a screening test, though it may be used in a workup if PSA is high.
What happens after a high PSA, and why the change now
Men with elevated PSA levels — 3.0 ng/mL or higher at ages 45 to 69, and 6.5 ng/mL or higher at 70 to 74 — should have a repeat PSA test between two weeks and three months, the ACS said. Those with a confirmed elevation should be offered MRI and/or a validated biomarker to help decide on a biopsy. Men diagnosed with low-risk prostate cancer should be offered active surveillance as the initial approach.
Prostate cancer is the second leading cause of cancer death in U.S. men, behind lung cancer. The ACS estimated 333,830 diagnoses and 36,320 deaths in 2026. Dr. William L. Dahut, the ACS chief scientific officer, told NBC News he hoped the guidelines "would increase screening for men at average risk and ultimately lead to a decrease of men with metastatic disease or dying from the disease, while mitigating harm." He also said Black men experience a 67% higher incidence and nearly double the mortality rate compared with White men, "an inequity that needs immediate reversal." NBC reported that a major European randomized study with more than two decades of follow-up was particularly influential in giving the authors more confidence that screening lowers deaths.
Lisa A. Lacasse, president of the ACS Cancer Action Network, said cost-sharing can still be a hurdle and that the advocacy affiliate will push for coverage of screening and follow-up. The guideline is not a mandate; it is a recommendation for men and their doctors.