American Cancer Society updates prostate screening, urging PSA tests every two years for average-risk men 50 to 69

The American Cancer Society said average-risk men should have PSA blood tests every two years from age 50 through 69. For Black men and men with a strong family history, the society recommended yearly PSA-based screening beginning at 45, strengthening prior guidance for higher-risk groups. Starting at 70, the decision should be individualized, and screening should stop after age 80 or when life expectancy is under 10 years.

The update rests on newer evidence that PSA screening can reduce prostate cancer-specific mortality in certain men, after the test had fallen out of favor because it is not specific enough. The prior 2010 American Cancer Society guidelines had left PSA testing to individual choice after risk assessment. The society set a high PSA threshold at 3.0 nanograms per milliliter or higher for men aged 45 to 69. The U.S. Preventive Services Task Force still recommends against routine population-wide screening, suggesting individualized decision-making, but has announced an update.

The revised pathway is designed to reduce the harms that made PSA screening controversial: false positives, unnecessary biopsies, and treatment of slow-growing tumors that may never threaten life. The guidelines now call for two elevated PSA readings, then an MRI scan or other biomarker tests before biopsy, with MRI still recommended before biopsy if a biomarker test is abnormal. They also emphasize active surveillance for slow-growing cancer, a strategy that follows known disease instead of immediately treating it.

The change affects millions of men and the healthcare economy because USPSTF recommendations determine insurance coverage for preventive services, and screening decisions can lead to imaging, biopsies, treatment, and years of monitoring. The society said Black men disproportionately die from prostate cancer and that earlier surveillance may reduce late-stage diagnoses. The evidence base is strongest for PSA screening reducing prostate cancer deaths in selected populations, but the guideline update itself cannot establish that the exact two-year interval, age range, or new biopsy safeguards improve net outcomes; real-world outcomes data would be needed.