The American Cancer Society has ended 16 years of caution on prostate cancer screening, telling men for the first time since 2010 that they should get a routine PSA blood test — every two years from age 50, and every year from age 45 for Black men and men with a strong family history.

Key Points

• Updated guidance published Thursday, November 12, 2026, in CA: A Cancer Journal for Clinicians — the first update since 2010.
• Average-risk men aged 50 to 69 should get a PSA blood test every two years, after doctors explain the benefits, limits and harms.
• Black men and men with a strong family history should be screened every year from 45 through 69; Black men face 67% higher incidence and nearly double the mortality of white men.
• A confirmed elevated PSA — 3.0 ng/mL or higher at 45 to 69, or 6.5 ng/mL or higher at 70 to 74 — should be repeated within two weeks to three months, then checked with MRI or biomarker tests before any biopsy.
• Men 70 to 74 should decide with a clinician; no routine screening at 75 and older. The society estimates 333,830 diagnoses and 36,320 US deaths in 2026.

What Happened

The society released its new guideline on Thursday, November 12, 2026, in CA: A Cancer Journal for Clinicians, its peer-reviewed journal. The update, led by authors including Richard Hoffman and Robert Smith, replaces 2010 guidance that asked men only to discuss the test with their doctor. That is the central change: the old guidance centred on shared decision-making without endorsing regular testing, while the new guidance makes a direct recommendation — average-risk men aged 50 to 69 should be screened every two years.

The guidance draws sharper lines by risk. Black men and men with a strong family history — a father or brother diagnosed before 65, or several first-degree relatives — should start annual screening at 45 and continue through 69. Non-Black men with one first-degree relative diagnosed at 65 or older should begin biennial screening at 45. For men 70 to 74, the society recommends an individual decision with a clinician, and routine screening is not recommended at 75 and older. After a high result, the test should be repeated within two weeks to three months; if confirmed, doctors should offer a prostate MRI or biomarker test before any biopsy.

Background: Sixteen Years of Caution Over the PSA Test

Prostate cancer is the second most common cancer in American men and the second leading cause of cancer death in men. The PSA test has been available for decades, but it is also one of the most contested tests in medicine: it finds cancers, but also many slow-growing tumours that would never cause symptoms, and a positive result can lead to biopsies and treatments carrying risks of incontinence and impotence. The 2010 guidance reflected that worry. What changed is the evidence — a systematic review, and a European trial of more than 182,000 men, in which men aged 55 to 69 invited to screening had a 20% lower relative risk of dying from the disease at 16 years of follow-up — plus MRI and biomarker tests that spare many men a needless biopsy.

Prostate Cancer Screening: What the New Guidance Says

The recommendations are organised by age and risk. For average-risk men, the schedule is a PSA test every two years from 50 to 69; for higher-risk men — Black men and men with a strong family history — it is every year from 45 to 69. The thresholds are explicit: a PSA of 3.0 ng/mL or higher between 45 and 69, or 6.5 ng/mL or higher between 70 and 74, should be confirmed with a repeat test within two weeks to three months. Only a confirmed elevation should lead to MRI or biomarker testing, and only those results should guide a biopsy. The aim is to catch lethal tumours early while sparing men unnecessary tests for slow-growing cancers.

Reactions: "A Critical Step" Toward Catching Lethal Tumours Early

"PSA testing remains the cornerstone of detecting prostate cancer early, and we now have stronger evidence of its benefits," said Robert Smith, senior vice president of early cancer detection science at the American Cancer Society and senior author of the report. "These updated guidelines are a critical step toward preventing diagnoses of advanced disease, reducing premature deaths, and minimizing treatment-related harms."

The society framed earlier, more frequent screening for Black men as a deliberate step against a long-standing disparity. "Our aim is also to help reduce prostate cancer disparities and ease the disease burden," said William L. Dahut, chief scientific officer at the American Cancer Society. "Black men experience a 67% higher incidence and nearly double the mortality rate compared with White men, an inequity that needs immediate reversal."

Why It Matters

The society estimates that 333,830 men in the United States will be diagnosed with prostate cancer in 2026, and that 36,320 will die from it. Most men diagnosed do not die from the disease, but for the minority whose cancer is aggressive, early detection is often the difference between a curable tumour and one that has spread. The disparity the guidance targets is one of the starkest in American medicine: Black men develop the disease at rates 67% higher than white men and die from it at nearly twice the rate.

What Happens Next

The guidance takes effect as advice, not as law. It is now up to doctors to bring it into the consulting room, and up to men — particularly those aged 45 to 69 — to ask about it at their next check-up. For men wondering what to do now, the message is simple: if you are 50 to 69, talk to your doctor about a PSA test every two years; if you are Black, or your father or brother was diagnosed before 65, start at 45, every year.

Frequently Asked Questions

Who should get screened, and when?

Average-risk men: a PSA test every two years from 50 to 69. Black men and men with a strong family history: yearly from 45 to 69. Men 70 to 74 should decide with their clinician.

What is a PSA test?

A blood test measuring prostate-specific antigen, a protein made by the prostate. A high level can signal cancer, but also an enlarged prostate or infection, so one high result is never enough alone.

What happens if my PSA is high?

Repeat the test within two weeks to three months. If the elevation is confirmed, your doctor should offer a prostate MRI or a biomarker test to help decide whether a biopsy is needed.

Why should Black men start earlier?

Black men face a 67% higher incidence and nearly double the mortality of white men. Earlier, yearly screening aims to close that gap.

Should men over 75 be screened?

No — routine screening is not recommended at 75 and older. Healthy men aged 75 to 79 with a rising PSA may consider continuing after talking with their doctor.

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