What You Need to Know About the Updated Prostate Cancer Screening Guideline
Prostate cancer is the most common cancer in men (after skin cancer) and the second-leading cause of cancer death among men in the United States. In 2026, an estimated 333,830 men will be diagnosed with the disease and more than 36,000 will die from it.
Now, the American Cancer Society has updated its prostate cancer screening guideline for the first time since 2010.
The new guideline reflects the latest evidence around prostate cancer screening and advances in how screening results can be used to guide care. The guideline continues to focus on finding potentially life-threatening cancers earlier while limiting unnecessary testing and treatment.
The updated guideline is published in CA: A Cancer Journal for Clinicians, the flagship journal of the American Cancer Society.
The Cancer Connections team spoke with Dr. William Dahut, the American Cancer Society’s chief scientific officer, to address some of the common questions about prostate cancer and the updated guideline. Here, he explains what’s changed, why screening matters, and how to make sense of the screening recommendations.
1. What causes prostate cancer?
Dr. Dahut: Prostate cancer develops when mutations, or changes, occur in the genes of normal prostate cells. The changes may cause the cells to grow out of control and eventually form a tumor.
What causes these mutations is not always known.
Researchers have identified factors that may increase a person’s risk. These include older age, race and ethnicity, family history, and inherited gene mutations.
Inherited gene mutations are thought to be a major factor in up to 10% of prostate cancers. Diet, obesity, smoking, and other lifestyle or environmental factors may also increase risk, but the link is unclear.
Having 1 or even several risk factors does not mean you will develop prostate cancer, and many people who develop the disease have few or no known risk factors.
2. What are some of the signs and symptoms of prostate cancer?
Dr. Dahut: Early prostate cancer usually doesn’t cause signs and symptoms, which is why screening is important.
When symptoms occur, they may include problems urinating, such as a slow or weak urine stream or needing to urinate more often, especially at night. Blood in the urine or semen are also possible signs.
More advanced prostate cancer can cause additional symptoms, such as bone pain, if the cancer has spread to the bones or other organs.
It’s important to remember that many of these signs and symptoms can be caused by conditions other than prostate cancer. But if you notice any, talk with your doctor to determine what may be causing them.
3. What does the new guideline say about prostate cancer screening and what’s changed?
Dr. Dahut: Previously, the American Cancer Society did not recommend a specific prostate cancer screening schedule. Instead, it recommended that men make a shared decision with their doctor about whether to be screened.
But we thought it was important to update our prostate cancer guideline because we now have stronger evidence that screening can lower a person’s chance of dying from prostate cancer.
The American Cancer Society now recommends that men at average risk get screened with a prostate-specific antigen (PSA) blood test every 2 years from ages 50 to 69.
Some men at higher risk should start earlier and, in some cases, be screened more frequently.
Black men, for instance, should have annual PSA screening from ages 45 to 69. Annual screening from ages 45 to 69 is also recommended for non-Black men with a strong family history of prostate cancer, such as a father, brother, or son diagnosed before age 65, or more than 1 first-degree relative diagnosed with prostate cancer before age 65.
For non-Black men with 1 first-degree relative who was diagnosed after age 65, the guideline recommends screening every 2 years from ages 45 to 69.
The updated guideline also includes a recommendation for secondary testing in most men with an elevated PSA, including an MRI and/or biomarker testing, to help determine whether a prostate biopsy is needed.
4. Why does the guideline differ for high-risk individuals, including Black men and those with a family history?
Dr. Dahut: The recommendations are different because some men face a greater risk of developing prostate cancer and dying from the disease.
Black men, for example, are 67% more likely to be diagnosed with prostate cancer and have nearly twice the mortality rate compared with White men. They are also more likely to be diagnosed at younger ages and with more aggressive disease. Men with a strong family history of prostate cancer, especially those with a first-degree relative, such as a father or brother, diagnosed at a younger age, may also be at increased risk of aggressive disease.
Screening high-risk men at younger ages may help reduce the risk of being diagnosed with advanced-stage disease or dying from prostate cancer and may help address some of the disparities we see in prostate cancer outcomes.
5. What are the screening recommendations for men ages 70 to 74, and why stop at 75?
Dr. Dahut: For men ages 70 to 74, the decision to continue prostate cancer screening should be a personal one because the balance of benefits and harms is less certain in this age group.
Overall health, life expectancy, personal preferences, and the potential harms of screening should all be considered. For men who choose to continue screening, PSA screening is recommended every 2 years.
Screening is not recommended for men age 75 and older or for any man with a life expectancy of less than 10 years because the potential benefits of screening generally decrease with age. Older men are also more likely to experience overdiagnosis, unnecessary biopsies, and complications from treatment.
For these reasons, the guideline aims to focus screening on men who are most likely to benefit while reducing the risk of unnecessary testing and treatment.
6. What happens when a PSA test result is high?
Dr. Dahut: First, it’s important to remember that an elevated PSA level does not mean you have prostate cancer. PSA levels can fluctuate, so the guideline recommends repeating the test within 2 weeks to 3 months to confirm the result. If a follow-up test shows the PSA is still elevated, then other tests such as an MRI of the prostate and/or a biomarker test should be the next step for most men.
This additional testing may provide more information and help determine whether a prostate biopsy is necessary. This can help some men avoid unnecessary biopsies, while identifying men who need further evaluation.
Ultimately, however, a prostate biopsy will be required to diagnose prostate cancer.
7. Why is prostate cancer screening so important?
Dr. Dahut: Men diagnosed with prostate cancer have better treatment options and have much higher survival rates when the disease is caught early.
For men diagnosed with prostate cancer before it has spread outside the gland or has only spread to nearby tissue, the 5-year relative survival rate is greater than 99%. If the cancer has metastasized, or spread elsewhere in the body, such as the liver or lungs, the survival rate drops to 38%.
8. Are there risks or harms of PSA screening, such as overdiagnosis and overtreatment?
Dr. Dahut: PSA screening can help detect aggressive prostate cancers earlier, but it has some potential downsides as well.
Screening may produce a false-positive result, where the PSA level is high, but a man doesn’t have prostate cancer. This could potentially lead to additional testing or a biopsy that ultimately does not find cancer. Prostate biopsies can have complications, including bleeding and infection. This is why the updated guideline recommends repeating the PSA test and then, if needed, getting other tests such as MRI or biomarker testing, before going straight to a biopsy for most men.
Another concern is overdiagnosis. Some prostate cancers grow so slowly that they would never have caused symptoms or affected a man’s health during his lifetime. Finding these cancers may potentially lead to treatment that isn’t necessary, which is known as overtreatment. Treating prostate cancer can have significant side effects, including urinary incontinence, erectile dysfunction, and bowel problems.
The updated guideline aims to limit overtreatment by recommending that active surveillance be offered as the initial management approach for men diagnosed with low-risk prostate cancer. Active surveillance means monitoring the cancer closely for signs that it may need treatment, instead of treating it right away.
If treatment becomes necessary at some point, options may include surgery or radiation therapy. The decision depends on the characteristics of the cancer, a man’s overall health, and his individual preferences.
The updated recommendations are meant to balance the potential harms with the benefits of screening.
9. What do you tell men who are hesitant about getting screened for prostate cancer?
Dr. Dahut: Prostate cancer screening is information. It gives you information about your own individual risk of having a cancer that should be treated. That information is helpful in making important decisions.
I also tell men that they are empowered to stop the screening process anywhere along the line. Men can work with their doctors and families to make informed decisions about what’s best, including whether to have more PSA testing, imaging, a biopsy, or treatment.
We’re much better now at determining which prostate cancers need treatment and which can be safely monitored. Having that information can be incredibly valuable when making decisions about your care. That’s one of the reasons we updated our screening recommendations.
Additional Resources:
Reviewed by the American Cancer Society communications team.
