ATLANTA
For a generation of American men, the question of whether to get a prostate cancer blood test came with a shrug. Talk it over with your doctor. Weigh the risks. Decide for yourself. As a result, many men never got the test at all.
That changed on Thursday. The American Cancer Society (ACS), one of the most influential cancer organizations in the country, issued a new guideline telling men plainly: get screened.
The updated recommendation, published November 12 in the journal CA: A Cancer Journal for Clinicians, is the society's first major rewrite of its prostate screening advice since 2010. That guideline focused on "informed decision-making" between a man and his doctor. The new one gives a direct recommendation to screen men at average risk, on a set schedule.
Experts say the shift could not come at a more urgent time. Prostate cancer diagnoses have been rising for years, with more men being found with cancer that has already spread.
The New Rules at a Glance
Under the updated ACS guideline:
The guideline still asks doctors to talk with patients about the benefits, limits and possible harms of screening before testing. The tone has changed, though. Screening is now the recommended default, not an open question.
A Disease on the Rise
The statistics explain why the society acted. About 1 in 8 American men will be diagnosed with prostate cancer during their lifetime. More than 330,000 people in the U.S. are expected to be diagnosed this year, according to Dr. Yaw Nyame, an associate professor at Fred Hutchinson Cancer Center who served on the ACS expert panel. Prostate cancer is the second-leading cause of cancer death among American men, behind only lung cancer.
The trend is worrying. Diagnoses rose about 3% a year from 2014 through 2022, and more of them are being caught at a late stage, when the cancer is harder to treat and far more likely to kill.
Early detection makes a big difference. When prostate cancer is found before it has spread, five-year survival is above 99%. Once it has spread to distant parts of the body, the outlook is much worse.
How We Got Here: A Decade of Confusion
To understand why the new guideline matters, you have to go back more than a decade. In the 2000s, PSA testing was widespread. Critics argued it was leading to overdiagnosis, finding slow-growing cancers that would never have harmed a man, and to overtreatment with surgery and radiation that could leave men incontinent or impotent.
In 2012, the U.S. Preventive Services Task Force (USPSTF), the independent panel whose advice shapes what insurers cover, went as far as recommending against routine PSA screening. Testing rates fell.
In 2018, the task force softened its stance. It gave PSA screening for men aged 55 to 69 a "C" grade, meaning the decision should be an individual one. That remains its official position, although its website shows an update is in progress.
Doctors say this left many men falling through the cracks. Without a clear recommendation, the conversation often never happened. "Many men were never offered the test," said Dr. Neeraj Agarwal, a medical oncologist and co-director of the Prostate Cancer Program at Dana-Farber/Harvard Cancer Center, who was not involved in the new guideline.
What Changed the Science
Two big developments pushed the ACS to change its advice. The first is stronger long-term evidence that screening saves lives. A 2025 European study published in the New England Journal of Medicine found that men offered repeated PSA testing were 13% less likely to die from prostate cancer.
The second is a change in what happens after an abnormal test. The biggest fear about PSA screening was that it led straight to biopsies and aggressive treatment. Today, doctors have more tools to tell dangerous cancers apart from harmless ones. After a high PSA result, MRI scans, biomarker tests and genomic tests can help identify which men have low-risk disease.
Many of those low-risk cancers can now be watched with "active surveillance" instead of being treated right away, which spares men unnecessary surgery and radiation. Agarwal said this approach has changed the balance of benefits and harms that once made screening so controversial.
Black Men Face a Higher Risk
The new guideline's earlier, yearly screening for Black men reflects a stark health gap.
About 1 in 6 Black men will be diagnosed with prostate cancer in their lifetime. Their risk of dying from the disease is two to four times higher than that of other men. Modeling studies estimate that Black men develop clinically significant disease three to nine years earlier than other men.
Some experts think the ACS should go further. Agarwal suggests Black men start screening at around age 40, in line with recommendations from the Prostate Cancer Foundation and the American Urological Association.
Access to care seems to be a big part of the gap. In equal-access health systems such as Veterans Affairs medical centers, the difference in outcomes between Black and White men is much smaller, which suggests that getting men tested and treated on time can save lives.
The Insurance Catch
The new guideline has one practical problem: insurance. Under the Affordable Care Act, insurers must cover preventive services rated "A" or "B" by the USPSTF without charging patients. PSA screening is still graded "C," so that mandate does not apply. Medicare covers prostate screening, but private insurers are not required to follow its lead, although many states have their own laws requiring coverage.
The costs can also come after the first test. A 2024 study in the journal Cancer found that more than three-quarters of privately insured men faced out-of-pocket costs for follow-up testing after an abnormal PSA, including MRI scans and biopsies.
Lawmakers in Washington have taken notice. Sens. John Boozman (R-Ark.) and Cory Booker (D-N.J.) introduced the PSA Screening for HIM Act last year. The bill would require insurers to cover PSA screening for high-risk men with no cost-sharing.
Expert Perspective
Panel member Dr. Yaw Nyame pointed to a useful detail for men getting their first test: a low baseline result is very reassuring. "If that first PSA is under 1 ng/ml, your lifetime risk of prostate cancer is much lower," he said.
Dr. Justin Gregg, an associate professor of urology and health disparities research at UT MD Anderson Cancer Center, who was not involved in the guideline, said PSA screening saves lives. He also noted that the guideline still calls for doctors and patients to discuss the benefits and harms before screening begins.
Taken together, the experts' message is that the test is simple and the follow-up tools are better than ever, and that the cost of missing an aggressive cancer is too high to leave screening to chance.
What This Means for You
If you are a man, or you love one, here is how to act on the new guidance:
Prostate cancer often causes no symptoms in its early stages. Problems with urination, blood in the urine or semen, or bone pain can be signs of more advanced disease and need prompt medical attention. Screening is meant to catch the cancer well before any of those appear.
The Bottom Line
For 16 years, America's leading cancer charity left men to decide for themselves whether to be tested for one of the most common cancers they face. Many didn't, and late-stage diagnoses have been climbing.
The new American Cancer Society guideline ends that uncertainty with a clear message: get the test. A simple blood draw every year or two, combined with modern imaging and the option of active surveillance, gives men a far better chance of catching dangerous cancer early, when it is almost always survivable.
The task force's long-awaited update, and the fight over insurance coverage, will decide how many men actually get screened. For now, doctors have a clear piece of advice: if you are 50, or 45 and at higher risk, book the test.
Sources: American Cancer Society / CA: A Cancer Journal for Clinicians; CNN Health; U.S. Preventive Services Task Force; New England Journal of Medicine; Cancer journal. This article is for general information and is not medical advice. Talk to your doctor about your personal screening plan.
