American Cancer Society calls for routine PSA screening every two years for men 50–69

For the first time since 2010, the American Cancer Society has stopped hedging. In guidelines published Thursday in CA: A Cancer Journal for Clinicians, the ACS now flatly recommends that men at average risk get a prostate-specific antigen blood test every two years from ages 50 to 69 — a direct call to action that replaces years of guidance telling men simply to 'discuss' the option with their doctors.

The shift is driven by two converging forces: stronger evidence that PSA screening saves lives, and a troubling rise in late-stage prostate cancer diagnoses that many experts link to a period of scaled-back testing. According to NBC News, an ACS study tracked a roughly 3% annual increase in prostate cancer diagnoses between 2014 and 2021, while metastatic cases climbed at about 6% per year among men 55 and older across a decade of data.

The new guidelines create a tiered system based on risk. Men at average risk get biennial screening from 50 to 69. Annual PSA screening starting at age 45 is recommended for two higher-risk groups: Black men, and non-Black men who have a father, brother, or son diagnosed before age 65, or more than one first-degree relative diagnosed with prostate cancer before age 65. For non-Black men with one first-degree relative diagnosed after age 65, the guideline recommends screening every two years starting at 45. Men ages 70 to 74 should discuss with their healthcare providers whether screening makes sense given their health and life expectancy, and routine screening is not recommended for most men 75 and older or those with limited life expectancy.

PSA testing remains the cornerstone of detecting prostate cancer early, and we now have stronger evidence of its benefits. We also have better approaches to catching lethal tumors while avoiding unnecessary tests for slow-growing cancers that may never need aggressive care.— Dr. Robert Smith, Senior Vice President, Early Cancer Detection Science, American Cancer Society

The guidelines also add a new step for men who test positive: secondary testing — including MRI and/or biomarker testing — is now recommended for most men with an elevated PSA, to help determine whether a biopsy is actually needed. That addition is designed to address one of the longest-standing criticisms of PSA screening: that it triggers unnecessary biopsies and treatment for cancers that would never have caused harm.

After skin cancer, prostate cancer ranks as the most common cancer affecting men, and it is the second-leading cause of cancer death among men in the United States. The ACS projects that 333,830 men will receive a prostate cancer diagnosis in 2026 and that more than 36,000 will die from the disease. Among men diagnosed with late-stage prostate cancer, only about one in three lives five more years, according to NBC News.

The history of PSA screening guidelines is a study in pendulum swings. Cancer surveillance use of the PSA test received FDA approval in 1986. Broad use of the test drove late-stage prostate cancer diagnoses down by more than half and cut the death rate by 7% by the mid-1990s, according to NBC News. But concern about overdiagnosis grew through the 2000s. In 2012, the highly influential U.S. Preventive Services Task Force issued a blanket recommendation against PSA testing for men of any age. The rate of late-stage diagnoses then began climbing once more.

A long-running randomized European study of PSA testing, now with more than two decades of follow-up data showing that screening in middle-aged men reduced prostate cancer deaths, was among the key influences on the new ACS guidelines, according to NBC News. Although the overall prostate cancer death rate dropped by half over the past three decades, that progress has leveled off among men between the ages of 55 and 69.

Black men experience a 67% higher incidence and nearly double the mortality rate compared with White men, an inequity that needs immediate reversal.— Dr. William Dahut, Chief Scientific Officer, American Cancer Society

The racial disparity is a central reason the guidelines treat Black men as a distinct high-risk group. According to the ACS, Black men face a 67% greater likelihood of a prostate cancer diagnosis and a mortality rate nearly double that of White men; they also tend to be diagnosed at younger ages and more often present with aggressive forms of the disease.

The previous guidelines' reliance on shared decision-making left too many men forgoing screening, ACS experts concluded. The new language is deliberately more directive, pushing clinicians to recommend the test rather than simply present it as an option — while still requiring that patients understand the potential benefits, limitations, and harms before starting.

Cancer still prompts a visceral, negative reaction in most people that for the most part is unwarranted in a lot of circumstances. There are more cancer survivors in the United States than ever before in history. That's only going to increase. And that's not because of overdiagnosis; that's because of more effective therapies for these patients.— Dr. Daniel George, Medical Oncologist, Duke Health

The harms of PSA screening remain real and are acknowledged in the guidelines. The test can produce false positives, biopsies carry health risks, and treatment — surgery and radiation — can cause sexual dysfunction, urinary incontinence, and bowel problems. Dr. Dahut noted that recent improvements in medical practice have helped mitigate those effects, and that doctors are now better able to differentiate cancers serious enough to need immediate treatment from those better managed through active surveillance.

The ACS describes the updated guideline as a 'living guideline,' meaning its scientists and volunteers will continue to monitor new evidence and update recommendations as clinical practices evolve. The U.S. Preventive Services Task Force has yet to bring its own guidance in line with this shift, while the ACS Cancer Action Network has said it intends to push for insurance coverage of prostate screening services, including follow-up testing, with no cost sharing.

Why it matters — For the roughly 333,000 American men expected to be diagnosed with prostate cancer in 2026, and the tens of millions more in the 50–69 age range, these guidelines shift the default from 'ask your doctor if you want a test' to 'your doctor should recommend one' — a change that could meaningfully affect how many men are diagnosed before their cancer spreads.

Reported by nbcnews.com, cancer.org, pressroom.cancer.org