New data
In announcing the guidelines today, the ACS says its updates are based on new evidence since 2010 that shows screening saves lives, and that advances in case management can avoid the concerning harms from overdiagnosis and overtreatment. For many men with prostate cancer, their cancer will never grow or cause harm in their lifetime, while treatment can run the risk of erectile dysfunction and urinary incontinence.
In the new guidance, the ACS adds guardrails, firstly advising all men to be informed about the risks and benefits. If a PSA test comes back high—defined as 3 ng/mL or higher for men under 70 and 6.5 ng/mL or higher for those 70 and up—the ACS recommends repeating the test before taking any next steps.
If repeat testing is still high, then men should get either a prostate MRI or a validated biomarker test to assess risk. Only if there is a high suspicion of cancer—such as having a very high PSA test result—should men jump to a prostate biopsy.
For men diagnosed with prostate cancer, active surveillance should be the initial management strategy for men whose cancer appears to be at low risk of growing or spreading.
“By catching aggressive cancers with a simple PSA blood test, you open the door to highly effective treatments that protect your future,” Dr. Shanthi Sivendran, interim chief patient officer for the ACS, said in a statement. “Meanwhile, lower-risk findings can be safely managed through careful, active surveillance.”
Prostate cancer is one of the most common cancers in men and the second leading cause of cancer death in US men, the ACS notes. Nearly 334,00 men are estimated to be diagnosed with prostate cancer in 2026, and it’s estimated that over 36,320 will die from the disease.
