50 to 69: American Cancer Society Urges Biennial PSA Screening

The American Cancer Society wants every man at average risk screened for prostate cancer. The group's new guidelines, released Thursday, call for a PSA blood test every two years from age 50 to 69. That marks a reversal from the organization's 2010 policy, which told men at 50 to use shared decision-making with a doctor rather than get routine testing, according to Ars Technica's report on the 2026 guidelines.

At What Age Should Men Start PSA Screening?

For men at average risk, the starting line is 50, per the American Cancer Society's 2026 guidelines. For men the group classifies as high risk, the number drops to 45. That high-risk group includes all Black men, who have higher rates of prostate cancer than the general population, the guidelines state. It also includes non-Black men with a close relative diagnosed with prostate cancer before age 65, or with more than one relative who has had the disease. A third group — non-Black men with a single relative diagnosed at 65 or older — also starts at 45, but under a lighter testing schedule described below.

How Often Should Testing Happen, and Who Counts as High Risk?

The interval depends on risk category. Average-risk men ages 50 to 69 get a PSA test every two years, the American Cancer Society's 2026 guidelines say. Black men starting at 45 are recommended to test every year. Non-Black men with a close relative diagnosed before 65, or with multiple affected relatives, also test yearly from 45. The exception is non-Black men whose only affected relative was diagnosed at 65 or older — they start at 45 but drop to the same two-year interval as average-risk men. The net effect is three different testing rhythms layered onto two different starting ages, all tied to family history and race-based risk data cited by the group.

What Happens If a PSA Test Comes Back High?

The guidelines set numeric thresholds for a second look. A PSA reading of 3 nanograms per milliliter or higher triggers follow-up for men under 70, according to the American Cancer Society's 2026 guidance. For men 70 and older, the threshold rises to 6.5 ng/mL. In either case, the first step is not a biopsy — it is a repeat test. If the second reading is still elevated, the guidelines call for a prostate MRI or a validated biomarker test before any biopsy decision. A biopsy is reserved for cases with high suspicion of cancer, such as a very high PSA result, per the group's framework as described by Ars Technica. For men who are diagnosed, the guidelines recommend active surveillance as the initial management strategy when the cancer appears low-risk — an approach aimed at avoiding the erectile dysfunction and urinary incontinence risks tied to treatment for cancers that, in many men, would never grow or cause harm during their lifetime.

What Changes After Age 70?

The guidelines taper off screening for older men. Those ages 70 to 74 are told to consult their doctor on whether to continue testing — no blanket yearly or biennial rule applies. Men 75 and older are not recommended to be screened at all under the 2026 guidelines. That endpoint sits in contrast to the newly expanded front end of the recommendation, which now applies to all average-risk men rather than leaving the decision to a case-by-case conversation.

How Does This Compare With Federal Screening Guidance?

The American Cancer Society's prior 2010 stance tracked closely with the U.S. Preventive Services Task Force, the federal panel that reviews evidence on preventive care — both groups favored shared decision-making over blanket recommendations. The task force is currently working on its own updated prostate screening recommendation, Ars Technica reports, though the outlet notes the panel has recently been overhauled by Health Secretary Robert F. Kennedy Jr., and that new members are reportedly carrying conflicts of interest. That leaves the two bodies — one voluntary health organization, one federal panel — potentially diverging on a question that affects men nationwide, with the Cancer Society now moving toward universal average-risk screening while the task force's revised position remains pending.

The American Cancer Society attributes its shift to evidence accumulated since 2010 showing that screening saves lives, paired with advances in case management — like active surveillance — that the group says can limit the overdiagnosis and overtreatment harms that made the 2010 panel cautious in the first place. The new guidelines pair the expanded testing mandate with explicit guardrails: repeat testing before escalation, imaging or biomarker tests before biopsy, and surveillance before treatment for low-risk cases. Whether that balance changes outcomes at scale will depend on how closely doctors and patients follow the sequence the group has now put in writing.