Published Nov 12, 2026 | 7:00 PM ⚊ Updated Nov 12, 2026 | 7:02 PM
The recommendations differ from India's approach to prostate cancer screening.
Synopsis: The American Cancer Society now recommends regular PSA-based prostate cancer screening for men aged 50 to 69, with earlier testing for high-risk groups. In India, ICMR advises against population-based screening, while the Urological Society of India supports individualised risk assessment for men over 50, reflecting differing approaches to early detection.
The American Cancer Society (ACS) has recommended regular prostate cancer screening for men aged 50 to 69, marking a shift towards more direct recommendations on early detection.
Its updated guidelines call for a prostate-specific antigen (PSA) blood test every two years for men at average risk, while recommending annual testing from the age of 45 for certain high-risk groups.
The recommendations, released on 12 November, also call for earlier screening among Black men and men with a strong family history of prostate cancer. The update reflects stronger evidence that PSA-based screening can reduce prostate cancer deaths and diagnoses of advanced-stage disease, alongside advances in follow-up investigations that can help minimise unnecessary biopsies and treatment.
The recommendations differ from India’s approach to prostate cancer screening. The Indian Council of Medical Research (ICMR), in its 2023 consensus document, does not recommend population-based screening for Indian men in any age group. The Urological Society of India (USI), in its 2022 guidelines, instead allows individualised risk assessment for men over 50 who have a life expectancy exceeding 10 to 15 years.
Under the updated ACS guidelines, men at average risk should undergo PSA-based screening every two years between the ages of 50 and 69.
For men at higher risk, including Black men and non-Black men with a strong family history of prostate cancer, annual screening is recommended from the age of 45 through 69. A strong family history is defined as having a first-degree relative diagnosed before the age of 65, or multiple first-degree relatives diagnosed with the disease.
Non-Black men with one first-degree relative diagnosed at 65 or older are advised to begin screening at 45 and undergo PSA testing every two years.
The guidelines recommend individualised decisions for men aged 70 to 74, as the balance between screening benefits and potential harms remains uncertain. Screening is not recommended for men aged 75 and older, or for those who are not expected to live for at least another 10 years.
The ACS has also clarified that an elevated PSA result does not automatically warrant a biopsy. Men aged 45 to 69 with PSA levels of 3 ng/mL or higher should repeat the test within two weeks to three months. If the level remains elevated, prostate MRI and/or validated biomarker tests should help determine whether a biopsy is necessary.
The guidelines do not recommend digital rectal examination (DRE) as a screening test.
“PSA testing remains the cornerstone of detecting prostate cancer early, and we now have stronger evidence of its benefits,” said Dr Robert Smith, senior vice-president of early cancer detection science at the ACS and a senior author of the report.
He said secondary testing after an elevated PSA result could help determine who needs a biopsy, who requires immediate treatment and who can be safely monitored through active surveillance.
The ACS also recommends active surveillance as the initial management option for men diagnosed with prostate cancer that has a low risk of growing or spreading.
The ICMR’s 2023 Consensus Document for Management of Prostate Cancer takes a more cautious position, stating that available evidence does not support routine screening of Indian men in any age group.
The document states: “As per the available evidence population based screening cannot be recommended in Indian population in any age group.”
It also says: “There has been no improvement in prostate cancer specific survival and overall survival by routine population based screening.”
The ICMR extends this position even to men carrying BRCA2 mutations, which are associated with an increased risk of clinically significant prostate cancer. It recommends counselling these men about their increased risk but says routine PSA screening cannot be recommended because of limited evidence.
The ICMR’s position reflects the evidence assessed when its consensus document was prepared in 2023. The ACS update, in contrast, cites more recent evidence on the benefits of PSA-based screening and advances in follow-up investigations.
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The USI’s 2022 guidelines do not rule out early detection. Instead, they allow doctors to assess an individual’s risk after the age of 50, provided the person has a life expectancy exceeding 10 to 15 years.
The guidelines state: “Personalized risk stratification may be undertaken for early detection on a case-to-case basis after the age of 50 when the life expectancy is >10–15 years and at-risk men must undergo both serum PSA and digital rectal examination (DRE).”
The society does not prescribe a definitive PSA cut-off for deciding on a prostate biopsy. However, it states: “No recommendation can be made on the cutoff of PSA values for considering a prostate biopsy. However, a PSA cutoff of 4 ng/ml can be considered for further evaluation.”
The USI also recommends considering multiparametric MRI in patients with elevated PSA levels and a negative DRE.
Unlike the ACS, which does not recommend DRE as a screening test, the USI recommends both PSA testing and DRE for men identified as being at risk.
The Indian society also asks doctors to consider a patient’s financial circumstances and access to healthcare facilities before recommending active surveillance for low-risk prostate cancer. This approach requires repeated PSA tests, examinations, imaging and, in some cases, biopsies.
Prostate cancer is an increasingly important cancer among men in India. According to the ICMR consensus document, the country recorded 41,532 cases in 2020, with projections exceeding 47,000 by 2025. The document also noted that prostate cancer had moved from eighth place in the 1990s to third place among cancers in men in Delhi and Mumbai.
The USI guidelines note that Indian men often present with PSA levels above 10 ng/mL and Gleason scores of 7 or higher. They also report a higher frequency of metastatic disease at presentation compared with Western populations. The ICMR consensus document puts the average age at diagnosis at 69.7 years.
PSA testing can identify prostate cancer before symptoms develop, but it can also detect slow-growing cancers that may never threaten a person’s life. Such diagnoses can lead to unnecessary biopsies and treatment, with possible complications including urinary incontinence and sexual dysfunction.
The ACS says advances in MRI, biomarker testing and active surveillance have helped clinicians distinguish potentially aggressive cancers from those that can be monitored without immediate treatment.
(Edited by Dese Gowda)
