Key Takeaways
- The American Cancer Society now directly recommends a PSA blood test every two years for average-risk men ages 50 to 69, its first guideline update since 2010.
- Black men and men with a strong family history should get a PSA test every year starting at age 45, the ACS says.
- A high PSA should be repeated within two weeks to three months, then checked with an MRI or a validated biomarker before any biopsy.
- Men 70 to 74 should decide with a clinician; routine screening is not recommended at 75 and older for most men.
The American Cancer Society (ACS) on Thursday told American men something it had not said plainly in 16 years: get screened for prostate cancer. In a major guideline update released Nov. 12, one of the nation’s leading cancer organizations recommended a prostate-specific antigen (PSA) blood test every two years for average-risk men ages 50 to 69, and every year starting at age 45 for Black men and men with a strong family history of the disease.
The change replaces years of “talk to your doctor” advice and comes as diagnoses of advanced prostate cancer keep climbing.
An estimated 333,830 U.S. men will be diagnosed with prostate cancer in 2026, and 36,320 will die from it, according to ACS figures. It is the second leading cause of cancer death in American men.
What do the new prostate cancer screening guidelines say?
The recommendations were published Thursday in CA: A Cancer Journal for Clinicians. According to the ACS announcement, the key points are:
- Average-risk men, 50 to 69: PSA-based screening every two years, after a clinician explains the benefits, limits and possible harms.
- High-risk men, 45 to 69: annual PSA screening for Black men and for non-Black men with a strong family history, meaning a father or brother diagnosed before age 65, or several first-degree relatives diagnosed at any age.
- One relative diagnosed at 65 or older: non-Black men in this group should be screened every two years from 45 to 69.
- Ages 70 to 74: an individual decision, because the balance of benefits and harms is uncertain.
- 75 and older: screening is not recommended, though some very healthy men 75 to 79 with a rising PSA may want to continue after talking with a provider.
- 80 and older, or a life expectancy under 10 years: screening is not recommended.
“PSA testing remains the cornerstone of detecting prostate cancer early, and we now have stronger evidence of its benefits,” said Dr. Robert Smith, the ACS senior vice president for early cancer detection science and the report’s senior author.
Why did the American Cancer Society change its advice now?
The previous ACS guideline, from 2010, asked men to weigh screening with their doctors. “Back in 2010, we actually didn’t have a strong opinion on whether or not one should be screened,” Dr. William Dahut, the ACS chief scientific officer, told Reuters. “It was unclear at that point whether the potential harms outweighed the benefits.”
Two things shifted. First, a large randomized European screening study, now with more than two decades of follow-up, found that PSA screening of middle-aged men lowered prostate cancer deaths, NBC News reported. Second, MRI scans and biomarker tests now help doctors separate dangerous tumors from slow-growing ones that can simply be watched.
An ACS study last year found prostate cancer diagnoses increased about 3% a year from 2014 to 2021, and metastatic cases in men 55 and older rose about 6% a year over a decade, according to NBC. Among men diagnosed with late-stage disease, only about a third live five more years.
Why are Black men told to start at 45 and test every year?
Black men have a 67% higher incidence of prostate cancer and nearly double the death rate of white men, the ACS said. “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,” Dahut said.
Some specialists would go further. Dr. Neeraj Agarwal, co-director of the Prostate Cancer Program at Dana-Farber/Harvard Cancer Center, who was not involved in the guideline, told CNN that Black men should start closer to age 40, in line with guidance from the Prostate Cancer Foundation and the American Urological Association. “Every year matters,” he said.
What happens if your PSA comes back high?
The new guideline treats the blood test as the first step, not a verdict. A PSA of 3.0 ng/mL or higher for men 45 to 69, or 6.5 ng/mL or higher for men 70 to 74, counts as elevated. The ACS says men with an elevated result should repeat the test within two weeks to three months. PSA can rise for reasons other than cancer, such as an enlarged prostate.
If the second test confirms a high level, men should be offered an MRI and/or a validated biomarker test to help decide whether a biopsy is needed. Men diagnosed with low-risk cancer should be offered active surveillance, meaning close monitoring instead of immediate surgery or radiation, as the first option.
“Your first PSA can be really powerful, especially when obtained in your 40s and 50s. It establishes a baseline,” Dr. Yaw Nyame, an associate professor at Fred Hutchinson Cancer Center who served on the expert panel, told CNN. “If that first PSA is under 1 ng/ml, your lifetime risk of prostate cancer is much lower.”
Does Medicare or insurance cover a PSA test?
For men on Medicare, Part B covers one PSA blood test every 12 months starting the day after a man’s 50th birthday. The test itself costs nothing when the provider accepts assignment. A digital rectal exam is also covered, with 20% coinsurance after the Part B deductible.
The bigger cost problem often comes after an abnormal result. “The PSA blood test itself is generally covered,” Agarwal told CNN. “The real problem is what comes next. If the PSA is high, the MRI, biomarker tests and biopsy are often billed as diagnostic care, so patients can face deductibles and coinsurance.”
Under the Affordable Care Act, private plans must cover a screening with no cost sharing when the U.S. Preventive Services Task Force gives it an A or B grade. The task force’s current recommendation, from 2018, calls screening an individual decision for men 55 to 69 (a C grade) and recommends against it at 70 and older. The task force says an update is in progress. The ACS’s advocacy arm says it will push for no-cost coverage of follow-up tests too.
What are the risks of PSA screening?
The test is not perfect. Many men with a high PSA do not have cancer, and screening can find harmless tumors. Treating those cancers can bring side effects such as incontinence and erectile problems. “It is an effective screening tool when it comes to reducing prostate cancer deaths, but it can come at that cost of unnecessary testing, patient anxiety and even unneeded treatments,” Nyame told CNN.
What should men and families do now?
- Know your start age: 50 for most men; 45 if you are Black or have a father or brother diagnosed before 65.
- Ask for a baseline PSA at your next checkup if you are in the recommended age range and have not had one.
- Ask what happens next if the number is high: a repeat test, an MRI or biomarker test, and whether active surveillance is an option.
- Check your costs: ask your plan how follow-up tests are billed. On Medicare, confirm the provider accepts assignment.
- Talk it through after 70: the ACS says screening at 70 to 74 depends on health and life expectancy.
The ACS also runs a 24/7 cancer helpline at 1-800-227-2345, and its prostate cancer screening page has more for patients. This article is not medical advice.
Frequently Asked Questions
At what age should men start prostate cancer screening?
The American Cancer Society now recommends a PSA test every two years starting at 50 for average-risk men, and every year starting at 45 for Black men and men with a strong family history.
How often should men get a PSA test?
Every two years for average-risk men 50 to 69, and every year for high-risk men 45 to 69, under the ACS guideline released Nov. 12, 2026.
What PSA level is considered high?
The new guideline treats 3.0 ng/mL or higher as elevated for men 45 to 69, and 6.5 ng/mL or higher for men 70 to 74. A high result should be repeated before further testing.
Does Medicare pay for a PSA test?
Yes. Medicare Part B covers one PSA blood test every 12 months for men over 50, and you pay nothing for the test if your provider accepts assignment.
Should men over 75 get screened for prostate cancer?
The ACS does not recommend routine screening at 75 and older, though some very healthy men 75 to 79 with a rising PSA may continue after talking with a provider.
Sources: American Cancer Society announcement (Nov. 12, 2026); ACS prostate cancer screening guideline; Reuters; CNN; NBC News; Medicare.gov; U.S. Preventive Services Task Force.
Top photo: A family medicine physician discusses men’s health with a patient during a routine exam at Landstuhl Regional Medical Center, June 12, 2018. U.S. Army photo by Stacy Sanning, public domain, via Wikimedia Commons. Illustrative.
