American Cancer Society Updates Prostate Cancer Screening Guidelines, Recommends Regular PSA Testing

The American Cancer Society (ACS) has released its first major update to prostate cancer screening guidelines since 2010, marking a significant shift toward regular PSA testing. Published on November 12, 2026, the recommendations reflect growing evidence that screening can reduce deaths from prostate cancer and diagnoses at advanced stages, while modern diagnostic approaches can help limit unnecessary biopsies and treatments.

For men at average risk, the ACS now recommends a PSA blood test every two years between ages 50 and 69. Black men, who face a higher risk of prostate cancer, should begin annual screening at age 45. The same schedule applies to men with a strong family history, including a father, brother, or son diagnosed before age 65, or multiple first-degree relatives affected by the disease. Men with only one first-degree relative diagnosed at age 65 or older should begin screening at 45, but every two years rather than annually.

The guidelines also address hereditary risk. Men carrying inherited mutations associated with prostate cancer, such as BRCA2, or those with a relevant family history of genetic alterations, should discuss individualized screening strategies with their healthcare providers.

For men aged 70–74, continued screening should be individualized after considering potential benefits, harms, and overall health. Routine screening is generally not recommended from age 75 onward, although exceptionally healthy men may discuss whether continued testing is appropriate. Screening is not recommended when life expectancy is less than ten years.

Importantly, an elevated PSA should no longer automatically lead to a prostate biopsy. The ACS recommends repeating an abnormal test, preferably within two weeks to three months. PSA levels of at least 3 ng/mL in men younger than 70, or 6.5 ng/mL in men aged 70–74, warrant further evaluation. When elevation is confirmed, prostate MRI and/or validated biomarkers can help determine whether a biopsy is necessary, although immediate biopsy may still be appropriate when clinical suspicion is particularly high.

Another essential component is active surveillance. Men diagnosed with low-risk prostate cancer should generally be offered careful monitoring rather than immediate radical treatment, reducing the risk of urinary, sexual, and bowel complications without abandoning appropriate cancer management.

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