Cancer Society Now Urges Regular PSA Tests for Most Men 50 to 69 in Its Biggest Prostate Screening Shift Since 2010

For the first time in more than 15 years, the American Cancer Society is telling most middle-aged men something simple: get tested. In a new guideline announced Thursday and published in the journal CA: A Cancer Journal for Clinicians, the society recommends that average-risk men ages 50 to 69 get a PSA blood test every two years ^[1][2].

That is a real change. The society's previous guidance, from 2010, told men to decide after discussing the pros and cons with their doctors, and the group took no firm position ^[1]. Dr. William Dahut, the society's chief scientific officer, put it candidly: "Back in 2010, we actually didn't have a strong opinion" ^[1]. Now it does, because the society concluded that the potential benefits of screening outweigh the potential harms ^[1].

What the New Guideline Says

The core recommendation is a PSA test every two years for average-risk men from 50 through 69 ^[1][2]. Men at higher risk start earlier. Black men, who have a 67% higher incidence of prostate cancer and nearly double the death rate of white men, are advised to be screened every year from 45 to 69, according to Reuters ^[1]. ABC News reported that men with a strong family history should also start at 45 ^[2].

The results of each test help set the schedule. ABC News reported that a PSA of 3.0 or higher calls for yearly screening, while a reading of 2.5 or lower allows testing every two years, and that a rising trend over time is more worrisome than a single abnormal result ^[2].

The guideline also tries to reduce the harms that made doctors wary of PSA testing in the first place. Before a biopsy is scheduled, men should have a repeat PSA test and an MRI, Reuters reported ^[1]. Men diagnosed with low-risk cancer should first be offered close monitoring rather than immediate surgery or radiation ^[1]. And men should still be told the risks and benefits before they are tested ^[1].

For older men, the advice tapers off. From 70 to 74, the balance of benefit and harm is uncertain, so men should talk it through with their doctors ^[1][2]. Screening is generally not recommended at 75 and older, though very healthy men from 75 to 79 may continue, especially if their PSA has been rising, and it is not recommended for men expected to live less than another 10 years ^[1].

Why the Society Changed Its Mind

The society pointed to stronger evidence that PSA screening saves lives, better tools to avoid unnecessary biopsies, a better ability to tell dangerous cancers from slow-growing ones that can safely be watched, and treatments with fewer side effects, including robotic surgery and more targeted radiation ^[1]. Dahut said the update is also meant to narrow the gap in prostate cancer outcomes between groups of men ^[1].

The stakes are high. The society estimates that 333,830 American men will be diagnosed with prostate cancer this year and 36,320 will die of it ^[1].

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The concerns have not disappeared. Screening can find cancers that would never have caused symptoms, leading some men into treatment that brings incontinence or impotence without extending their lives ^[1]. ABC News also listed false positives and overtreatment among the risks ^[2].

How It Compares With Other Advice

The new guideline goes further than the federal government's preventive-care panel. The U.S. Preventive Services Task Force, in its most recent recommendation process, called PSA screening for men 55 to 69 an individual decision, with benefits and harms closely balanced, and recommended against screening men 70 and older ^[3]. In 2023 the task force opened a review aimed at updating that advice, including a look at MRI and tools that help doctors decide who needs a biopsy ^[4].

Other medical groups differ, too. ABC News reported that the American Academy of Family Physicians does not recommend routine PSA screening, while the American Urological Association advises screening for men 55 to 69, with higher-risk men starting earlier ^[2]. ABC noted that official changes in practice can take years, though many doctors already follow the cancer society's lead ^[2].

The Takeaway for Men and Their Families

For men in their 50s and 60s, the message is now clearer than it has been in a generation: a simple blood test, repeated on a schedule, is worth doing. For Black men and men whose fathers or brothers had prostate cancer, the advice is to start at 45 and test every year.

Taking care of your health is not only about you. It is about being there for a wife, for children and grandchildren, and for a church and community that count on you. If you are in the age range, put the conversation with your doctor on the calendar before the new year, and bring this guideline with you.