New ACS Guidelines Push for Earlier Prostate Cancer Screening

Updated guidance recommends biennial prostate-specific antigen testing for average-risk men aged 50 to 69 years and annual screening beginning at age 45 for higher-risk men. The American Cancer Society (ACS) updated its prostate cancer screening guideline to recommend regular prostate-specific antigen (PSA)-based testing for men at average risk aged 50 to 69 years, with earlier and more frequent screening for men at increased risk.

Published November 12, 2026, in CA: A Cancer Journal for Clinicians , the recommendations also outline additional testing strategies to guide biopsy decisions and reduce unnecessary procedures. 1,2 The update is the first revision to the ACS prostate cancer screening guideline since 2010 and incorporates evidence supporting PSA-based screening to reduce prostate cancer mortality and advanced-stage diagnoses.

The recommendations also account for advances in diagnostic testing and active surveillance intended to minimize harms associated with overdiagnosis and overtreatment. ACS Recommends Risk-Based PSA Screening Intervals Under the updated guideline, the ACS recommends PSA-based screening every 2 years for average-risk men aged 50 to 69 years.

Clinicians should discuss the potential benefits, limitations, and harms of screening with patients before testing. 1 For men at increased risk, screening should begin earlier. Black men and non-Black men with a strong family history of prostate cancer should undergo annual PSA-based screening beginning at age 45 and continuing through age 69.

A strong family history includes having a first-degree relative diagnosed before age 65 or multiple first-degree relatives diagnosed at any age. For non-Black men with a single first-degree relative diagnosed at age 65 years or older, screening is recommended every 2 years between ages 45 and 69.

These recommendations reflect differences in prostate cancer risk across populations. Black men experience a 67% higher incidence of prostate cancer and nearly twice the mortality rate compared with White men, according to William Dahut, MD, chief scientific officer at the ACS and a contributing author of the guideline, in the news release announcing the update.

2 “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,” said Dahut. Elevated PSA Levels Warrant Additional Evaluation The guideline establishes a pathway for evaluating elevated PSA levels before proceeding to prostate biopsy.

For men aged 45 to 69 years, a PSA level of 3.0 ng/mL or higher warrants repeat testing. For men aged 70 to 74 years who elect to continue screening, the corresponding threshold is 6.5 ng/mL or higher. 1 Repeat testing should occur between 2 weeks and 3 months after an elevated result.

If the elevation is confirmed, clinicians should offer additional evaluation with MRI and/or a validated biomarker to help determine whether biopsy is warranted. These strategies aim to reduce unnecessary biopsies while improving the identification of clinically significant prostate cancer .

PSA testing is an initial screening tool, and an elevated result does not independently establish a prostate cancer diagnosis. “PSA testing remains the cornerstone of detecting prostate cancer early, and we now have stronger evidence of its benefits,” Robert A. Smith, PhD, senior vice president of early cancer detection science and director of the Center for Early Cancer Detection at the ACS, said in the news release.

Smith is the senior author of the guideline report. 2 ACS Addresses Screening in Older Men and Active Surveillance For men aged 70 to 74 years, screening decisions should be individualized based on overall health, life expectancy, and patient preferences. Routine screening is not recommended for men aged 75 years and older or those with a life expectancy of less than 10 years.1 The guideline also emphasizes active surveillance as the initial management approach for men diagnosed with prostate cancer at low risk of progression.

This approach can help limit unnecessary treatment-related harms in patients whose disease may not require immediate intervention. The ACS developed the recommendations through a systematic evidence review and modeling study evaluating the benefits and harms of PSA-based screening strategies.

The guideline also reflects advances in MRI, biomarker testing, and active surveillance that can help clinicians better distinguish clinically significant disease from cancers that may not require immediate treatment. An estimated 333,830 men in the US will be diagnosed with prostate cancer in 2026, and approximately 36,320 are expected to die from the disease, according to the ACS’s news release.

The ACS plans to continue monitoring emerging evidence and updating its recommendations as clinically meaningful advances in prostate cancer screening and diagnosis become available. REFERENCES 1. Hoffman RM, Wolf AMD, Etzioni RD, et al.

American Cancer Society guideline for the early detection of prostate cancer, 2026. CA Cancer J Clin . 2026;76(6):e70112. doi:10.3322/caac.70112 2.

American Cancer Society updates prostate cancer screening guideline: Major changes include regular PSA testing for average and high-risk men. News release. American Cancer Society.

November 12, 2026. Accessed November 13, 2026. https://pressroom.cancer.org/prostate-cancer-screening-guideline-update-2026 Related to this article