The American Cancer Society (ACS) has issued a major change to its prostate cancer screening guidance, now advising routine testing for many men after concluding that the potential benefits of screening are greater than its possible harms in the current clinical context.
Under the revised recommendation, published in CA: A Cancer Journal for Clinicians, the ACS endorses blood tests that measure prostate-specific antigen (PSA) levels every two years for men at average risk between the ages of 50 and 69. Men with a family history of prostate cancer are recommended to be screened annually. For Black men - who the society notes have a 67% higher incidence of prostate cancer and nearly double the mortality rate compared with white men - the guidance calls for annual testing beginning at age 45 and continuing through age 69.
The guidance marks a departure from the ACS position issued in 2010, when the organization did not take a firm stance for or against screening and advised men to make individualized decisions after discussing potential benefits and harms with their healthcare providers. ACS Chief Scientific Officer Dr. William Dahut said at the time that the evidence then made it unclear whether harms outweighed benefits. The new guidance reflects the ACS view that accumulating evidence and medical advances have shifted that balance.
The ACS projects that 333,830 men in the United States will be diagnosed with prostate cancer in 2026 and that 36,320 men will die from the disease. Those estimates frame the society's effort to refine screening recommendations to achieve net benefit across diverse patient groups.
Age-specific guidance and caveats
The new guidance makes clear distinctions by age and risk profile. For men aged 70 to 74, the balance of benefits and harms is described as uncertain; the guideline recommends doctors discuss screening with these men to arrive at an individualized decision. The ACS advises against routine screening for men aged 75 and older, while acknowledging that some very healthy men aged 75 to 79 may opt to continue screening, particularly if prior PSA tests showed rising values. Screening is not recommended for men aged 80 and older or for those whose life expectancy is less than 10 years.
Steps to limit harms from diagnostic and treatment pathways
To reduce the potential harms associated with PSA-based screening - notably unnecessary biopsies and overtreatment - the guideline continues to recommend that men receive information about the risks and benefits of PSA testing before it is performed. It also calls for a repeat blood test and a magnetic resonance imaging (MRI) study before scheduling a biopsy. For men found to have low-risk prostate cancer, the guideline advises offering close monitoring, rather than immediate active treatment, as the initial management approach.
These measures are intended to address long-standing concerns that universal screening could detect many cancers that would not have caused symptoms, and that treatment of such cancers can lead to side effects including incontinence and impotence without meaningful survival benefit.
Rationale cited by the ACS
The ACS cites stronger evidence for the benefits of PSA-based screening in combination with wider adoption of management strategies that can mitigate harms. The society notes improvements in clinicians' ability to distinguish high-risk prostate cancers from tumors that can be safely observed. It also points to improvements in therapies, including fewer side effects from treatments, the use of robotic surgery to raise quality of care, and more targeted, higher-quality radiation therapy.
"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," Dr. William Dahut said.
The ACS emphasizes that the new guidance is intended to reduce disparities in incidence and mortality, and to ease the overall burden of disease by recommending earlier and more frequent screening where the society judges net benefit is more likely.
The guidance combines specified screening intervals, age limits, pre-biopsy diagnostic steps, and a preference for surveillance in low-risk cases as a package designed to balance benefit and harm in the era of improved diagnostics and treatments.