ACS Rewrites Prostate Cancer Screening Guidelines, Urges Tests at 50
The American Cancer Society now recommends a PSA blood test every other year for most men from age 50, and yearly from 45 for Black men and those with a strong family history. Rising advanced-stage diagnoses and long-term European data drove the change.
The American Cancer Society (ACS) said Thursday, November 12, 2026, that most men ages 50 to 69 should get a prostate-specific antigen (PSA) blood test every other year, replacing prostate cancer screening guidelines it published in 2010.
The change matters because advanced prostate cancer is rising in the United States. It is the second-leading cause of cancer death among men, behind lung cancer.
Men at higher risk should be tested every year, starting at age 45. That covers Black men, who have higher rates of the disease and are likelier to die from it. It also covers men whose father or brother was diagnosed under age 65, or who have several relatives diagnosed at any age.
Men ages 70 to 74 should decide with their health care providers whether to be tested, based on their health and life expectancy. The guidelines were published in CA: A Cancer Journal for Clinicians.
From choice to a clear recommendation
The earlier guidance stressed shared decision-making between men and their doctors. The new version is much more direct.
"At that point it wasn't really clear that with prostate screening, the benefits outweigh the harms," said Dr. William Dahut, the ACS chief scientific officer, referring to 2010. Two things have changed since, he said. Doctors have reduced the harms of screening, and long-term studies, mainly in Europe, show that men screened every two years die less often from prostate cancer.
One major randomized European study now has more than two decades of follow-up. The ACS authors said it gave them the confidence to recommend the test and to be specific about who should have it and how often.
The guidelines define an abnormal PSA result as 3 nanograms per milliliter or higher for men 69 and younger. For men 70 to 74, the threshold is 6.5 ng/mL or higher. An elevated reading does not always mean cancer, because an enlarged prostate or, less often, an infection can raise PSA.
Why the swing back
The US Food and Drug Administration approved the PSA test for cancer surveillance in 1986. Late-stage diagnoses then fell by more than half, and the death rate dropped 7% by the mid-1990s.
Concern about overdiagnosis and unnecessary treatment later narrowed screening advice. In 2012, the US Preventive Services Task Force recommended against PSA testing for men of any age. Late-stage diagnoses then began to creep up.
An ACS study last year found prostate cancer diagnoses rose about 3% a year from 2014 to 2021. Metastatic cases, where the cancer has spread, rose about 6% a year in men 55 and older.
Dr. Neeraj Agarwal of the Dana-Farber Cancer Institute, who was not involved in the update, said leaving the decision to each patient and doctor meant many men were never offered the test. "A clear recommendation fixes that," he said.
Dahut said he hopes the guidelines will raise screening among average-risk men and "ultimately lead to a decrease of men with metastatic disease or dying from the disease, while mitigating harm."
