The American Cancer Society now recommends regular PSA screening, changing its previous guidance

On November 12, 2026, the American Cancer Society (ACS) returned to recommending regular PSA screening for many men. Since 2010, it had asked men to decide case by case with a clinician. The new guidance still calls for a discussion of benefits and harms before testing.

At Empirical Health, a PSA test costs $19 as an add-on to a blood-testing program. Screening can prevent some prostate cancer deaths, but a high result can lead to a biopsy or a diagnosis of a cancer that would never cause symptoms. Here is who should test, why the advice changed, and what happens after a high result.

Was PSA screening recommended before?

ACS advised yearly PSA testing starting in 1992, then moved to informed choice in 2010. The U.S. Preventive Services Task Force (USPSTF) has never recommended routine PSA screening. In 2018, it moved from recommending against testing to an individual decision for men ages 55–69.

ACS now recommends regular PSA screening; the USPSTF’s next update has no announced date. Sources: ACS recommendation history, USPSTF recommendations, and its update in progress.

Who should get a PSA test, and how often?

The new ACS guideline recommends:

Group	Recommended PSA screening
Men at average risk, ages 50–69	Every 2 years
Black men, ages 45–69	Every year
Non-Black men with a first-degree relative diagnosed before 65, or multiple first-degree relatives diagnosed at any age, ages 45–69	Every year
Non-Black men with one first-degree relative diagnosed at 65 or older, ages 45–69	Every 2 years

A first-degree relative here means a father, brother, or son. Men with an inherited condition linked to prostate cancer, or a close relative with such a mutation, should ask a clinician when to start screening and how often to test.

At ages 70–74, the benefit is less certain. Men who continue screening should test every two years. ACS advises against screening at 75 or older, though some very healthy men ages 75–79 may choose to continue after talking with a clinician. It discourages screening after 80 or when life expectancy is under 10 years.

ACS doesn’t recommend a digital rectal exam for screening. Symptoms or a previous abnormal PSA call for an individual evaluation instead of the routine schedule above.

Why do the screening ages matter?

Prostate cancer becomes more common with age, but PSA also rises in many men without cancer. In the European screening trial’s first round, false-positive results rose from 3.5% in men younger than 55 to 20.6% in men 70 or older. Those numbers come from an older testing and biopsy pathway. Sources: USPSTF evidence review and age-specific trial table.

Our PSA accuracy explainer examines sensitivity, specificity, and typical PSA levels by age.

How many cancers does a PSA test catch or miss?

A 2026 Swedish study followed 12,670 men ages 50–74 for two years after one PSA test. At a 3 ng/mL cutoff, it found these outcomes per 1,000 men for clinically significant cancer (grade group 2 or higher):

Outcome over two years	Per 1,000 men
Cancer detected after a positive PSA	25.8
Cancer diagnosed after a negative PSA	9.2
Positive PSA without clinically significant cancer diagnosed	94.9
Negative PSA without clinically significant cancer diagnosed	870.1

Here, “false positive” means no clinically significant cancer was diagnosed within two years; some men in that group may have had low-risk cancer. The study measured one test, not the full ACS screening pathway. Source: Palsdottir et al., Annals of Internal Medicine, 2026.

Why did the USPSTF stop short of recommending routine PSA screening in 2018?

In 2018, the USPSTF moved from advising against PSA screening to recommending an individual decision for men ages 55–69. It still advised against screening at 70 or older.

The task force estimated that screening 1,000 men ages 55–69 could prevent about 1.3 prostate cancer deaths and 3 metastatic cancers over roughly 13 years. But in the evidence it reviewed, more than 15% of screened men had a false-positive PSA result over 10 years. About 1% of biopsies caused complications requiring hospitalization, and an estimated 20%–50% of screen-detected cancers were overdiagnosed. These estimates come from older screening and treatment pathways. USPSTF, 2018.

The false-positive and overdiagnosis estimates have different denominators. Source: USPSTF, 2018.

Dr. Alex Krist, who helped write the USPSTF guidance, warned The New York Times that physicians are “just going to get this test on everyone.” He worries that more testing could bring more biopsies and treatment harms than ACS predicts. ACS still calls for an informed discussion before screening starts.

What did the 2026 Cochrane review find?

The 2026 Cochrane review examined six trials involving nearly 790,000 men. Across five PSA screening trials, evidence for fewer prostate cancer deaths was low certainty. The 23-year follow-up of one European trial offered moderate-certainty evidence: 14 prostate cancer deaths per 1,000 men offered screening versus 16 without screening. The review found no clear reduction in deaths from all causes.

The European trial also found 156 prostate cancer diagnoses per 1,000 men offered screening versus 120 without it. Some of the 36 extra diagnoses may have been cancers that would never cause symptoms. The review couldn’t directly measure overdiagnosis or overtreatment; data on biopsy complications and quality of life were limited. Cochrane cautions against treating this as an endorsement of screening everyone.

The European trial found two fewer prostate cancer deaths and 36 more diagnoses per 1,000 men offered screening; the chart uses different scales for deaths and diagnoses. Source: Franco et al., Cochrane Database of Systematic Reviews, 2026.

Why did the ACS advice change?

ACS cites longer trial follow-up showing fewer prostate cancer deaths and advanced diagnoses. Its new pathway aims to limit harm by confirming a high PSA, using MRI and/or a biomarker test to guide biopsy, and offering active surveillance for low-risk cancer.

These safeguards depend on clinicians using them. A high PSA can have a benign cause; a slow-growing cancer may never cause symptoms. Biopsies can cause complications, and treatment can impair urinary and sexual function.

What happens if PSA is high?

ACS considers a PSA of at least 3.0 ng/mL elevated at ages 45–69, or at least 6.5 ng/mL at ages 70–74. It recommends repeating a high result in 2 weeks to 3 months. If PSA remains high, most men should be offered a prostate MRI and/or a validated biomarker test to help decide whether to biopsy. A lower-concern result may allow biopsy to be deferred; a very high PSA may warrant one without MRI. MRI helps guide the decision but cannot diagnose cancer by itself. ACS guideline.

After a biopsy confirms low-risk cancer, ACS recommends offering active surveillance first. Monitoring includes PSA tests, repeat biopsies, and possibly MRI. It can delay or avoid surgery or radiation, but MRI doesn’t replace every follow-up biopsy. ACS guideline.

MRI may help avoid biopsy after a high PSA and may help monitor low-risk cancer after diagnosis; the historical harm rates apply only to people who underwent each named procedure. Sources: ACS, 2026 and USPSTF, 2018.

How does PSA compare with other cancer screening?

The chart places the Swedish PSA results beside modeled estimates for breast, colorectal, cervical, and lung screening from our Galleri analysis.

The PSA row shows observed outcomes after one test and two years in men ages 50–74. The other rows model annual outcomes per 1,000 adults ages 50–74, including people ineligible for each test; their “missed” counts include cancers arising between screens. The groups differ in population, time frame, and cancer definition, so the bar lengths do not rank screening programs. Sources: PSA cohort and Galleri model.

What should you do now?

If you’re in a recommended age group, ask which testing interval fits your risk. Before your first test, discuss when to repeat a high PSA, when MRI or another test might help, and whether you’d choose active surveillance for a low-risk cancer. ACS recommends this discussion before screening starts.