The American Cancer Society now recommends regular prostate cancer screening for most men. For 16 years it had left the choice to a talk with a doctor.
Its updated guideline, published Thursday, Nov. 12, calls for a PSA blood test every two years from 50 to 69 for men at average risk. Black men and men with a strong family history should start at 45 and test every year.
The stakes are large. The ACS estimates 333,830 American men will get a prostate cancer diagnosis this year and 36,320 will die of it, according to its news release. It is the second leading cause of cancer death in US men. The guideline also tells doctors what to do after a high result, the step where screening has done the most harm.
What the ACS changed after 16 years
The society’s 2010 guideline did not tell men to get tested. Men with at least 10 years of life ahead were to get “an opportunity to make an informed decision” with their provider. Average-risk men would start that talk at 50, and higher-risk men earlier.
The 2026 version makes a direct recommendation. Dr. Richard Hoffman is the first author, and CA: A Cancer Journal for Clinicians published it.
The ACS ran a systematic review and commissioned a modeling study. It “concluded that the benefits of screening outweigh the harms,” the abstract says.
“PSA testing remains the cornerstone of detecting prostate cancer early,” said Dr. Robert Smith, the report’s senior author, in the release. He added that “we now have stronger evidence of its benefits.”
The strongest new evidence comes from a European trial of 162,236 men aged 55 to 69. Its 23-year results appeared in The New England Journal of Medicine in October 2025. Men offered repeated PSA tests had 13% fewer prostate cancer deaths. For every 456 men invited, screening averted one death.
That is a real benefit, but a small one for each man. The same trial shows the cost: the screening group had 30% more prostate cancer diagnoses. The trial’s authors say future screening should aim to cut that overdiagnosis.
Dr. Neeraj Agarwal of the Dana-Farber/Harvard Cancer Center was not on the panel. He told CNN (via KSL) that under the old approach “a lot of men were simply never offered the test.”
The guideline at your age
We built this table from the journal abstract, the ACS release and the society’s recommendations page, revised Nov. 12. A strong family history means a father, brother or son diagnosed before 65. It also covers men with more than one such relative, at any age.
These are general recommendations, not advice for any one man. The ACS says each man should decide with his doctor. We took the same by-age approach in our guide to women’s heart health across four life stages.
| Age | What the ACS guideline says | PSA level for follow-up |
|---|---|---|
| Under 45 | No schedule. Men with gene changes such as BRCA2 should ask a provider when to start. | Not set. |
| 45 to 49 | Black men: every year. Strong family history: every year. One relative diagnosed at 65 or older: every two years. Others: not yet. | 3.0 ng/mL or higher. |
| 50 to 69 | Average risk: every two years. Higher-risk men keep their schedule. | 3.0 ng/mL or higher. |
| 70 to 74 | A personal decision, as the balance is uncertain. If testing goes on, every two years. | 6.5 ng/mL or higher. |
| 75 to 79 | Not recommended. Some very healthy men, especially with a rising PSA, may continue after talking with a provider. | Not set. |
| 80 and older | Not recommended. | Not set. |
| Under 10 years’ life expectancy | Not recommended at any age. | Not set. |
The ACS page also says the digital rectal exam is not recommended as a screening test. A doctor may still use it to look into symptoms or a high PSA.
A high PSA now leads to more tests before a biopsy
The guideline treats the PSA test as the start of a process, not a diagnosis. PSA levels move around, so a man with a high reading should repeat the test, ideally two weeks to three months later. If it stays high, most men should get the offer of a prostate MRI, a validated biomarker test or both.
Only then does a biopsy come up.
That extra step targets the harms the ACS lists on its explainer for patients. False positives lead to more tests. Biopsies can cause bleeding and infection. Screening also finds slow cancers that would never have mattered, and treating them can bring incontinence, erectile dysfunction and bowel problems.
A biopsy remains the only way to confirm the disease, the ACS says.
For low-risk cancer, the guideline makes active surveillance the first option. That means close monitoring instead of immediate surgery or radiation. Dr. William Dahut, the ACS’s chief scientific officer, summed up the society’s view on its patient page: “Prostate cancer screening is information.”
For other cancer research we have covered this autumn, see the pancreatic cancer vaccine trial that missed its goal and who the melanoma vaccine intismeran is for.
Why Black men start at 45
The earlier start for Black men follows the gap in outcomes. Black men have a 67% higher incidence than White men and nearly double the death rate, Dahut said in the release. He called it “an inequity that needs immediate reversal.” The ACS patient page adds that Black men tend to get diagnosed younger, with more aggressive disease.
Some specialists want an even earlier start. Agarwal told CNN that the American Urological Association and the Prostate Cancer Foundation both suggest Black men begin around 40.
Dr. Yaw Nyame of Fred Hutchinson Cancer Center served on the ACS panel. He told CNN that a first result shapes later choices: “If that first PSA is under 1 ng/ml, your lifetime risk of prostate cancer is much lower.”
How it compares with the federal task force
The ACS now goes further than the US Preventive Services Task Force. The task force’s current recommendation dates from May 2018. It gives screening a grade C for men 55 to 69, meaning an individual decision after a talk with a clinician. From 70, it recommends against PSA screening.
So a man of 50 now hears “get tested every two years” from the ACS. The federal panel’s advice does not start until 55.
The task force says it is updating the topic. Its final research plan, dated Dec. 21, 2023, asks about MRI and risk calculators after a positive PSA. That is the step the ACS has now adopted.
The task force’s update page lists no draft recommendation yet.
Cost is the other open question. Lisa Lacasse, president of the ACS Cancer Action Network, said out-of-pocket costs are “a significant hurdle.” Her group will push for screening and follow-up tests with no cost sharing, the release says. The ACS calls the document a “living guideline” that it will revise as evidence comes in. The next marker is the task force’s own draft, and whether it moves toward the same schedule.
