Reversal: American Cancer Society Urges Routine Prostate Screening With New Age-Based Guidance
Who should be screened
Under the new guidelines, men at average risk should have a PSA test every two years from age 50 through 69. Men ages 70 to 74 should discuss continued screening with a doctor, while screening is not recommended from age 75 onward.
The ACS recommends yearly testing from age 45 for all Black men. Non-Black men should also start yearly screening at 45 if a close relative was diagnosed before 65 or if more than one relative has had prostate cancer. If one close relative was diagnosed at 65 or older, testing should begin at 45 and occur every two years.
A shift from earlier advice
The update reverses the ACS’s 2010 approach, which made no universal recommendation for routine screening. At that time, men starting at age 50 were advised to decide with their doctors whether to be tested.
The society says evidence since 2010 indicates screening saves lives, while improved management can reduce harms from overdiagnosis and overtreatment. Some prostate cancers never grow or cause harm during a man’s lifetime, and treatment can lead to erectile dysfunction or urinary incontinence.
Steps after a PSA test
The ACS advises men to understand screening’s risks and benefits. A result of at least 3 ng/mL for men under 70, or at least 6.5 ng/mL for those 70 and older, is considered high; the test should be repeated before further action.
If the repeat result remains high, the next step should be a prostate MRI or validated biomarker test to assess risk. Biopsy is advised only when suspicion of cancer is high, such as with a very high PSA result.
Managing diagnosed cancer
For men whose diagnosed cancer appears unlikely to grow or spread, the ACS recommends active surveillance as the initial management strategy. This approach is intended to monitor lower-risk disease while avoiding immediate treatment.
Dr. Shanthi Sivendran, the ACS interim chief patient officer, said a PSA test can help identify aggressive cancers for treatment, while lower-risk findings can be managed through active surveillance. The ACS estimates that nearly 334,000 men will be diagnosed in 2026 and more than 36,320 will die from prostate cancer.
Key points
- Average-risk men should receive PSA screening every two years from ages 50 to 69.
- All Black men and some non-Black men should begin screening at 45.
- High PSA results should be repeated and assessed before a biopsy is considered.
- Active surveillance is recommended initially for prostate cancers at low risk of spreading.