American Cancer Society updates prostate cancer screening guidelines, recommends regular PSA testing

The American Cancer Society (ACS) has issued updated prostate cancer screening recommendations that call for regular prostate-specific antigen (PSA)-based testing in average-risk and high-risk men, including earlier and more frequent screening for Black men and men with a strong family history of prostate cancer.^1,2

The recommendations, published November 2026, in CA: A Cancer Journal for Clinicians, represent a shift from the organization's previous guidance, which emphasized shared decision-making without making a direct recommendation for routine screening.

Under the updated guidance, average-risk men aged 50 to 69 years should undergo PSA-based screening every 2 years, while Black men and men with a strong family history of prostate cancer should begin annual screening at age 45. The recommendations also emphasize additional risk assessment following an elevated PSA result, including repeat testing and the use of magnetic resonance imaging (MRI) or validated biomarkers to inform biopsy decisions.

"PSA testing remains the cornerstone of detecting prostate cancer early, and we now have stronger evidence of its benefits," said Robert Smith, PhD, senior vice president of early cancer detection science and director of the Center for Early Cancer Detection at ACS, and senior author of the report, in the news release.² "We also have better approaches to catching lethal tumors while avoiding unnecessary tests for slow-growing cancers that may never need aggressive care. The PSA test is just the first step in a screening process. Secondary testing for men with elevated PSA levels determines who needs a biopsy if an individual has prostate cancer, and if so, who needs immediate treatment and who can be safely monitored via active surveillance. These updated guidelines are a critical step toward preventing diagnoses of advanced disease, reducing premature deaths, and minimizing treatment-related harms."

The guideline update reflects evolving evidence regarding the benefits of PSA-based screening in reducing prostate cancer mortality and diagnosis of advanced-stage disease. The recommendations are intended to improve detection of clinically significant prostate cancer while limiting the potential harms associated with screening and subsequent interventions.

Updated screening recommendations

The ACS recommends screening according to age and individual risk, with the following distinctions:

For average-risk men aged 50 to 69 years, PSA-based screening should be performed every 2 years. Before initiating screening, clinicians should ensure that patients understand the potential benefits, limitations, and harms of testing.

For men at higher risk, including Black men and non-Black men with a strong family history of prostate cancer, annual screening should begin at age 45 and continue through age 69. The ACS defines a strong family history as having a first-degree relative diagnosed before age 65 years or having multiple first-degree relatives diagnosed at any age.

Non-Black men with a single first-degree relative diagnosed at age 65 years or older should undergo screening every 2 years beginning at age 45 and continuing through age 69.

For men aged 70 to 74 years, the ACS recommends individualized decision-making about whether to continue screening, as the balance of potential benefits and harms remains uncertain. Routine screening is not recommended for men aged 75 years and older or those with a life expectancy of less than 10 years. However, the guideline notes that particularly healthy men aged 75 to 79 years with rising PSA levels may consider continued screening following discussion with their clinician.

The recommendations also establish specific thresholds for further evaluation. Men aged 45 to 69 years with PSA levels of 3.0 ng/mL or higher and men aged 70 to 74 years with levels of 6.5 ng/mL or higher should undergo repeat PSA testing within 2 weeks to 3 months. If the elevation is confirmed, clinicians should offer prostate MRI and/or a validated biomarker to help determine whether prostate biopsy is warranted.

For men diagnosed with prostate cancer considered to have a low likelihood of growing or spreading, active surveillance should be offered as the initial management approach.

Evidence informing the guideline update

To develop the updated recommendations, ACS conducted a systematic review of the available evidence and commissioned a modeling study to evaluate the benefits and harms associated with different PSA-based screening strategies. An interdisciplinary Guideline Development Group comprising clinicians, epidemiologists, biostatisticians, and patient representatives reviewed the evidence and developed the recommendations.

A major consideration was the growing body of evidence supporting a reduction in prostate cancer mortality with PSA-based screening. In the European Randomized Study of Screening for Prostate Cancer (ERSPC), a multicenter randomized trial involving more than 182,000 men, investigators reported a 20% relative reduction in prostate cancer mortality at 16 years among men aged 55 to 69 years who were invited to screening (rate ratio, 0.80; 95% CI, 0.72 to 0.89; P < .001).³ The absolute difference in prostate cancer mortality between screening and control groups increased to 0.18% at 16 years.

Thus, the updated recommendations aim to reduce uncertainty surrounding the effectiveness of prostate cancer screening and emphasize the importance of early detection.

"By making a direct recommendation for men to engage in screening and advocating for earlier and more frequent screening for Black men, our aim is also to help reduce prostate cancer disparities and ease the disease burden," said William L. Dahut, MD, chief scientific officer at the American Cancer Society and a contributing author of the study.² "Black men experience a 67% higher incidence and nearly double the mortality rate compared with White men, an inequity that needs immediate reversal."

According to the ACS, scientists and volunteers will continue to monitor the evidence base for new screening and treatment strategies as they become available and will update recommendations accordingly.

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REFERENCES

1. Hoffman RM, Wolf AMD, Etzioni RD, et al. American Cancer Society guideline for the early detection of prostate cancer, 2026. CA Cancer J Clin. 2026;e70112. doi:10.3322/caac.70112

2. American Cancer Society Updates Prostate Cancer Screening Guideline: Major Changes Include Regular PSA Testing for Average and High-Risk Men. News release. American Cancer Society. November 12, 2026. Accessed November 12, 2026. https://pressroom.cancer.org/prostate-cancer-screening-guideline-update-2026

3. Hugosson J, Roobol MJ, Månsson M, et al. A 16-yr Follow-up of the European Randomized study of Screening for Prostate Cancer. Eur Urol. 2019;76(1):43-51. doi:10.1016/j.eururo.2019.02.009