- The American Cancer Society now recommends prostate-specific antigen (PSA) screening starting at age 50, ending 16 years of leaving the choice to men and their doctors
- Black men and men with a strong family history should begin annual PSA screening at age 45, with testing every two years for average-risk men ages 50 to 69
- New PSA threshold of 3.0 ng/mL for men under 70 triggers a repeat test and possible MRI rather than immediate biopsy
- Low-risk prostate cancer diagnoses should first be managed with active surveillance instead of automatic surgery or radiation
- PSA screening is no longer recommended from age 75 or for men with a life expectancy under 10 years
For sixteen years, the American Cancer Society told men to figure out prostate cancer screening on their own after a chat with their doctor, but that advice has now changed. In a major policy reversal published Thursday in CA: A Cancer Journal for Clinicians, the organization now actively recommends men get their prostate-specific antigen, or PSA, numbers checked at regular intervals starting at age 50. The change comes as fresh long-term European trial data shows screening actually cuts deaths, and as diagnoses of advanced prostate cancer keep piling up.
Annual screening starts earlier for Black men and men with family history
The new guidelines mark a clear departure from the "informed decision-making" model the ACS had pushed since 2010. For average-risk men aged 50 through 69, the ACS now recommends PSA screening every two years. This carries a "B" rating, which is a sign the ACS is fairly confident the test does more good than harm at these ages.
Riskier situations call for more frequent testing. Black men, who die of prostate cancer at nearly twice the rate of white men, should begin annual PSA screening at age 45 through 69. Men with a strong family history — a first-degree relative diagnosed before 65, or multiple first-degree relatives at any age — should follow the same schedule. Those with a single first-degree relative diagnosed at 65 or older can start every-two-year screening at 45.
The goal is straightforward: catch the disease early, when treatment works best. When the cancer is caught before it spreads, men with prostate cancer have a five-year survival rate above 99%.
New PSA thresholds and better tools aim to cut down on unnecessary biopsies
One high PSA reading no longer sends a man straight to the biopsy table. Under the updated guidance, the cutoff is 3.0 nanograms per milliliter for men 69 and younger and 6.5 ng/mL for men 70 to 74. A reading at or above that line should trigger a second test within two weeks to three months rather than immediate alarm.
If the second test still comes back high, the guidelines recommend offering an MRI and/or a validated biomarker test to help decide whether a biopsy is truly needed. The idea is to filter out the false alarms that have long plagued PSA screening. The blood draw itself is nearly risk-free; the trouble is that a high reading can kick off a chain of painful procedures and anxiety over slow-growing cancers that might never cause harm.
According to the ACS, new prostate cancer diagnoses increased by roughly 3% a year from 2014 to 2022, and advanced cases rose the quickest. But the ACS believes modern tools now give doctors the ability to separate dangerous cancers from harmless ones, making regular screening safer than it used to be.
Active surveillance replaces automatic treatment for low-risk cases
Here's the part that should reassure men who are worried about over-treatment: a low-risk diagnosis no longer means rushing into surgery or radiation. The ACS now recommends that men diagnosed with low-risk prostate cancer first be offered active surveillance — keeping a close eye on the cancer through periodic PSA checks, imaging and biopsies, and only treating it if it starts to progress. An increasing number of men are already taking this approach and passing on surgery.
The ACS also suggests when screening should wind down. Routine PSA testing is no longer recommended once a man turns 75, or for those who are not expected to live another 10 years. Men aged 70 to 74 should make a decision with their doctors based on their health and preferences.
The ACS is betting that a clear, direct recommendation will do what years of vague "talk to your doctor" guidance could not: get more men into the screening chair before their cancer becomes incurable.
However, men have seen this advice swing back and forth before. A federal panel advised them to skip PSA tests entirely in 2012, then softened its stance six years later. The wisest move is to be aware of your own risk, ask what happens after a high reading, and make the call that is right for you, not just whatever the official advice happens to be this decade.
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