New guidelines recommend regular prostate cancer screening for all middle-aged men

by Dennis Thompson

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Experts now recommend regular prostate cancer screening for all men ages 50 to 69 and earlier for higher-risk groups, according to new American Cancer Society (ACS) guidelines.

Until now, the ACS recommended that men make an informed decision with their doctors about whether to receive a prostate-specific antigen (PSA) test to assess their prostate cancer risk.

However, the new guidelines reflect updated data showing that the benefits of PSA testing outweigh the potential risk of false negatives or unnecessary treatment, ACS experts said.

Specifically, the ACS cited improvements in the way that doctors interpret and assess an elevated PSA reading, reducing the risk of treating prostate cancer that might not be life-threatening.

"PSA testing remains the cornerstone of detecting prostate cancer early, and we now have stronger evidence of its benefits," senior researcher Robert Smith said. He is the senior vice president of early cancer detection science at the ACS.

"We also have better approaches to catching lethal tumors while avoiding unnecessary tests for slow-growing cancers that may never need aggressive care," he added in a news release.

The guidelines now recommend that men 50 to 69 at average risk receive a PSA test every two years, according to a report published today in CA: A Cancer Journal for Clinicians.

Black men and those with a strong family history of prostate cancer should start testing at age 45, the guidelines recommend.

PSA testing can continue through age 75, with men in their 70s making an informed decision about whether to continue screening, the guidelines suggest.

"By making a direct recommendation for men to engage in screening and advocating for earlier and more frequent screening for Black men, our aim is also to help reduce prostate cancer disparities and ease the disease burden," researcher Dr. William Dahut, chief scientific officer at the cancer society, said in a news release.

"Black men experience a 67% higher incidence and nearly double the mortality rate compared with white men, an inequity that needs immediate reversal," Dahut said.

Prostate cancer is the second leading cause of cancer death among men in the United States, the ACS says. About 333,830 men will be diagnosed with prostate cancer this year, and 36,320 will die of the disease.

The last ACS screening guideline for prostate cancer, published in 2010, was released just after two major trials reported conflicting findings about the benefit of screening, researchers noted.

Treating prostate cancer has been a subject of debate because surgery and radiation can cause incontinence and impotence among patients. Prostate cancers are typically slow-growing, which means some men might suffer these side effects for a tumor that would not have contributed to their deaths.

"Think of prostate cancer screening as an early warning system for your health," Dr. Shanthi Sivendran, interim chief patient officer for the ACS, said in a news release. "By catching aggressive cancers with a simple PSA blood test, you open the door to highly effective treatments that protect your future. Meanwhile, lower-risk findings can be safely managed through careful, active surveillance."

The guidelines also recommend enhanced PSA testing among men with elevated PSA levels of 3.0 ng/mL or higher for men 45 to 69, and 6.5 ng/mL or higher for men 70 to 74. These men should undergo repeat testing two weeks to three months later.

Men with a confirmed elevated PSA should be offered MRI testing and counseling to help guide their decisions about a biopsy, the guidelines said.

"The PSA test is just the first step in a screening process," Smith said. "Secondary testing for men with elevated PSA levels determines who needs a biopsy, if an individual has prostate cancer, and if so, who needs immediate treatment and who can be safely monitored via active surveillance.

"These updated guidelines are a critical step toward preventing diagnoses of advanced disease, reducing premature deaths, and minimizing treatment-related harms," he added.

Dr. James Eastham, a urologic surgeon at Memorial Sloan Kettering Cancer Center in New York City, said his main quibble with the new guidelines involves stopping screening at age 75.

"Guidelines have to be generalizable, so there are always some compromises," said Eastham, who was not involved in crafting the guidelines.

"I am not a fan of using chronologic age as a cut-point. I prefer physiologic life expectancy, meaning an estimated 10-year or more life expectancy as being a reasonable candidate to discuss prostate cancer early detection," he said. "Age is certainly a key factor, but overall health plays a role, too."

More information

Richard M. Hoffman et al., American Cancer Society guideline for the early detection of prostate cancer, 2026, CA: A Cancer Journal for Clinicians (2026). DOI: 10.3322/caac.70112

Key medical concepts

Prostate Cancer ScreeningProstate Cancer

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OncologyMen's healthUrologyCommon illnesses & PreventionPreventive medicine Who's behind this story?

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