The American Cancer Society now recommends that men at average risk of prostate cancer have a PSA blood test every two years from age 50 through 69, and that Black men and men with a strong family history be tested every year from 45 through 69. The guideline, published November 12, 2026, in CA: A Cancer Journal for Clinicians, replaces a 2010 version that made no direct recommendation for or against screening and instead asked men to decide with their doctor.

The ages and the intervals

The 2026 guideline sorts men into risk groups and attaches a schedule to each. Men at average risk: a PSA test every two years, ages 50 through 69. Black men: a PSA test every year, ages 45 through 69. Men who are not Black but have a strong family history, defined as a father, brother or son diagnosed before age 65 or more than one first-degree relative diagnosed at any age: every year, ages 45 through 69. Men with one first-degree relative diagnosed at 65 or older: every two years, ages 45 through 69. For men with an inherited gene change such as BRCA2, the society's patient page says start age and frequency should be worked out with a provider.

At 70 through 74 the guideline asks for an individualized decision, because it judges the balance of benefits and harms in that window uncertain; men who do continue are tested every two years. At 75 the society recommends stopping. Very healthy men 75 through 79 may choose to continue after a discussion, particularly if their PSA has been rising, and screening is discouraged at 80 and older and at any age for a man not expected to live another 10 years. The digital rectal exam is not recommended as a screening test.

What happens after a high result

The guideline also sets thresholds. A PSA of 3.0 ng/mL or higher is considered elevated for men 45 through 69; for men 70 through 74 the cutoff is 6.5 ng/mL. An elevated result is to be repeated between two weeks and three months later, and a confirmed elevation should lead to a prostate MRI, a validated biomarker test, or both, before any decision about a biopsy. For a man diagnosed with low-risk prostate cancer, the guideline says active surveillance should be offered as the first management option. The society describes the document as a living guideline that it intends to update as evidence arrives.

How it differs from 2010

The 2010 ACS guideline stopped short of recommending screening. It said most men should make an informed decision with their health care provider after learning about the uncertainties, risks and potential benefits. The 2026 version makes a direct recommendation for regular PSA-based screening while keeping the requirement that clinicians make sure a man understands the benefits, limitations and harms before the first test. The society gives two reasons for the shift: stronger evidence that PSA screening lowers prostate cancer deaths and diagnoses of advanced-stage disease, and the arrival of tools, MRI, biomarker tests and active surveillance, that reduce the unnecessary biopsies and overtreatment that drove the earlier caution.

How it differs from the U.S. Preventive Services Task Force

The federal task force's current recommendation dates from May 2018. For men 55 through 69 it gives a Grade C: the decision to have periodic PSA screening should be an individual one, made after a conversation about benefits and harms, and clinicians should not screen men who do not express a preference for it. For men 70 and older it gives a Grade D, recommending against PSA screening. The task force does not set a screening interval, does not start at 50, and does not single out Black men or men with a family history for a different schedule. Its website notes that an update of this topic is in progress; the only document posted so far is a final research plan, and the page was last updated December 21, 2023.

The two bodies now diverge on the central question. The task force leaves the decision open for men 55 through 69. The cancer society recommends testing for men 50 through 69 and starts five years earlier for higher-risk groups, while still requiring the pre-test conversation.

The evidence behind the guideline

The guideline was written by a 21-member interdisciplinary volunteer group of clinicians, epidemiologists, biostatisticians and patient representatives, with the society's own researchers among the authors. It rests on a systematic evidence review and a modeling study of PSA screening strategies that the American Cancer Society commissioned to weigh benefits against harms across ages and intervals. The published abstract states the society's conclusion that the benefits outweigh the harms for the recommended groups. Only the abstract could be opened for this article, so the detailed evidence tables and the certainty grades attached to each recommendation are not reported here. The press release does not state a funding source beyond the society itself.

The society estimates 333,830 new prostate cancer diagnoses and 36,320 deaths in the United States in 2026, making it the second leading cause of cancer death in men. It reports that Black men have a 67 percent higher incidence rate than White men and close to double the death rate, which is the basis for the earlier, annual schedule.

The full guideline and a companion patient page are open at the journal's website, and the society has rewritten its public recommendations page to match. For a man in his mid-forties or older, the guideline itself frames the first step as a conversation with a clinician about which risk group he falls into and what a PSA result would and would not mean.

This article reports research and expert guidance. It is not medical advice. Talk to your clinician before changing medication, treatment or a medical diet.

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