The American Cancer Society released an updated prostate cancer screening guideline on Thursday that makes a direct recommendation for routine PSA blood testing, a shift from its previous advice, which stressed shared decision-making without recommending screening for most men. The guideline was published in CA: A Cancer Journal for Clinicians.
Who should be tested, and how often
Men at average risk should have a PSA test every two years from age 50 to 69, with clinicians making sure patients understand the benefits, limits and harms before starting. Black men and non-Black men with a strong family history should begin at 45 and test every year through 69. The society defines a strong family history as a first-degree relative diagnosed before 65, or several first-degree relatives diagnosed at any age. Men aged 45 to 69 with a PSA of 3.0 ng/mL or higher should be evaluated further, and the guideline sets out a path for men aged 70 to 74 as well.
Why the advice changed
The update rests on a systematic evidence review and a modelling study commissioned by the society. That work concluded that PSA screening lowers deaths from prostate cancer and reduces diagnoses at an advanced stage, and that modern approaches to a raised PSA can cut unnecessary biopsies and treatment. Better imaging, risk calculators and active surveillance have changed what happens after a test comes back high, which weakens the old argument that screening does more harm than good.
The numbers explain the urgency. The society estimates 333,830 new prostate cancer cases in the United States in 2026 and 36,320 deaths. Prostate cancer is the most common cancer in men after skin cancer, and Black men die from it at roughly twice the rate of white men.
The harm side
Screening still carries costs. A raised PSA can lead to biopsy, infection and anxiety, and some detected tumours would never have caused symptoms. The guideline keeps an explicit role for shared decision-making and says the society's living guideline process will keep monitoring evidence and update the advice. Urologists welcomed the change; some primary care groups said they will need clear materials to explain the trade-offs in a ten-minute visit. The practical effect is that millions of men who never discussed a PSA test will now be offered one by default.