Prostate Cancer Screening: Get The Actual Guidelines For Men, Why Doctors Don’t Agree, And What You Need To Know To Make Decisions

Currently, there is no uniform federal guideline that everyone agrees on when in comes to prostate cancer screening.  Instead, men encounter a patchwork of recommendations from government panels and leading health organizations, often with conflicting advice.

That confusion may leave many men unsure when to be screened, particularly those over age 70 — a group that represents a large share of diagnosed cases.

USPSTF: Federal Guidelines Have Not Changed Since 2018

The chief federal guideline-setting body in the United States, the U.S. Preventive Services Task Force (USPSTF), currently recommends that men ages 55 to 69 make an individual decision about prostate cancer screening with a prostate-specific antigen (PSA) blood test after discussing the benefits and harms with their clinician. The recommendation is graded “C,” meaning the choice should be based on personal values and preferences.

For men 70 and older, the USPSTF explicitly advises against routine PSA screening, concluding that in this age group the potential harms — like false positives, unnecessary biopsies, and treatment side effects — outweigh the benefits.

But that’s where the consensus ends. And many doctors note that the USPSTF guidelines have not been updated since 2018.

American Cancer Society Guidelines

Unlike the USPSTF’s blanket stance, the American Cancer Society (ACS) encourages men to talk with their health care provider about prostate cancer screening earlier.

The USPSTF suggests beginning that conversation at:

• Age 50 for average-risk men
• Age 45 for men at higher risk (including African American men or those with a family history)
• and age 40 for those with especially strong family histories

After shared decision-making, men who choose screening should receive a PSA blood test; a digital rectal exam (DRE) may also be done as part of that discussion.

The American Urological Association (AUA) Guidelines

The AUA suggests general PSA screening can begin in most men between the ages of 45-50, with intervals every two to four years if chosen, and earlier screening for high-risk men.

They do not recommend routine screening for men 70 or older or those with shorter life expectancies.

What To Know About Screening After Age 70

The prostate cancer screening guidelines offer little to no guidance for men 70 and older. The USPSTF’s recommendation that men refrain from regular screening after age 70 is particularly concerning given recent data released in 2025 by the Centers for Disease Control and Prevention (CDC) showing that 43% of newly diagnosed prostate cancer patients were 70 or older.   The agency adds that from 2003 to 2022, the age range that saw the most prostate cancer cases was 70 and older.

In May of 2025, former president Joe Biden revealed publicly he had been diagnosed with stage prostate cancer at age 82, opening up a very public debate about whether or not older men should be screened routinely.

Former ABC News and Good Morning America Medical Director Dr. Timothy Johnson,  recently announced his prostate cancer diagnosis at age 89.  He told SurvivorNet that continued prostate cancer screening into a man’s 70s, 80s, and beyond isn’t clear-cut. However, he prefers to lean on the side of caution and continue screening.

“I think all I can really honestly say is after age 75, I would personally, if I’m in good health and mentally intact, continue yearly testing for a few years. If it remains very low, you might test every two years or, eventually, every three years,” Dr. Johnson said.

“But if it starts increasing during your yearly testing after 75, keep an eye on it; if it reaches a certain threshold, discuss potential treatment options. So I think we have to be very flexible and not rigidly follow those guidelines.”

PSA Vs. Digital Rectal Exam: What’s Enough?

Another point of confusion for many men contemplating screening is whether the PSA blood test alone is enough for screening, or whether a digital rectal exam (DRE) should be part of the process. The new Super Bowl ad emphasizes that prostate cancer screening “starts with a simple blood test” and directs viewers to an interactive website for more information.

The USPSTF does not recommend routine DRE as a primary screening tool. Its guidance focuses on PSA testing because evidence supporting DRE’s effectiveness in reducing mortality is limited. Many expert groups — including the ACS and cancer centers — continue to consider DRE a possible adjunct to PSA, particularly for men with elevated PSA or risk factors.

Urologic Surgeon Dr. Jeffrey Jones from Baylor College of Medicine, himself a prostate cancer survivor, told SurvivorNet, “I do not think it is appropriate to downplay digital rectal examinations. While not the most sensitive means to diagnose prostate cancer, there are a few cancers with low expressing PSA, which may be found via DRE; and DRE can provide other information such as anal sphincter tone in diagnosing neuromuscular conditions, rectal carcinoma, etc.”

Dr. Jones, the subject of a SurvivorNet original documentary film about his prostate cancer journey added, “There is still value to a thorough history and physical examination, when properly taught and employed, for diagnosis of medical conditions.”

To cut through some of the ongoing confusion about prostate cancer screening, SurvivorNet recently turned to Dr. Shirin Razdan, a urologic surgeon from the International Robotic Institute HCA Kendall Hospital in Florida for help.

WATCH: Myth-Busting Prostate Cancer Screening Understanding PSA, Digital Exams & Family Risk

Bottom Line: Talk With Your Doctor

For now, the lack of uniform guidelines means that the decision about prostate cancer screening — when to start, whether to continue past 70, and what tests to include — must be personalized.

Experts agree that shared decision-making between men and their clinicians, taking into account individual risks, values, and health status, is the best approach amid these conflicting recommendations. And as with any cancer, any patients in higher risk groups are encouraged to begin these conversations with their doctors even earlier.

Prostate Cancer Risk For Black Men

Since Black men tend to be diagnosed with prostate cancer at younger ages compared to other racial groups, Black men should consider screening earlier. Based on elevated risk data compiled, a study released by the New England Journal of Medicine in 2024 recommends Black men begin regular PSA screening between age 40-45.

In recent years, several high profile African-American men with prostate cancer have called for more awareness and support for men in communities of color.   A couple of celebrity survivors are subjects of new films in SurvivorNet’s documentary film series, Men Beating The Odds, including TODAY Show host Al Roker, and NBA Legend Alonzo Mourning. The landmark film series also shines a light on one charismatic survivor from St. Louis named Mellve Shahid, who created one of the nation’s only support networks dedicated to supporting Black men with prostate cancer.

What Role Does The Gleason Score Play In Prostate Cancer Screening?

The Gleason score is a critical tool for assessing the cancer’s aggressiveness. It ranges from 6 (least aggressive) to 10 (most aggressive), based on how abnormal the cancer cells appear and how they’re arranged.

WATCH: Understanding Gleason Score

This score helps oncologists determine whether the cancer is likely to grow slowly or spread quickly — information that directly influences treatment planning.

Once the Gleason score is established, doctors need to know whether the cancer is confined to the prostate or has spread beyond the prostate, also called metastasis.

After testing and establishing your risk, your doctor will discuss possible treatment options. These may range from active surveillance to more aggressive options, including surgery, radiation therapy and targeted radioligand therapy.

Prostate Cancer Impacts Men In Different Ways

Prostate cancer does not always behave the same in every man it impacts. The cancer can be considered “low-risk” and can be slow-growing, and treatment might not be necessary.  In other men, the cancer may grow faster or more aggressively, requiring more immediate treatment. As a result, there is some debate about screening.

“Active surveillance is monitoring those who have a localized, low-risk or very low-risk prostate cancer,” Dr. James Brooks, Chief Urologic Oncology at Stanford Medicine, explains to SurvivorNet.

“That means very small amounts of cancer on biopsy, low-grade cancer, low PSA. Usually, a normal examination– no signs that the cancer has spread outside the prostate. For men with those low-risk prostate cancers, we watch them,” Dr. Brooks added.

While on “watch,” these patients actively have a physician check their PSA and perform a digital rectal examination.

SurvivorNet’s Prostate Cancer Resources

SurvivorNet offers a multitude of resources for men seeking more information about prostate cancer screening, early detection, and biopsy, including this Patient Guide to Prostate Cancer Testing.

For men who are diagnosed with prostate cancer, whether it be early stage or advanced, the good news is that there are many treatment options available: from surgery and radiation, to newer targeted treatments for patients with advanced prostate cancer called radioligand therapy.

SurvivorNet also encourages men and their families to take advantage of its proprietary AI generated, doctor-backed “My Health Questions” feature, where users can get real-time answers to virtually any question they have about testing, symptoms, diagnosis and treatment, and for those diagnosed, information about current and upcoming clinical trials available, SurvivorNet also offers a helpful, interactive Clinical Trial Finder.

Importance Of Screening For Prostate Cancer

Learn more about SurvivorNet's rigorous medical review process.

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