The short answer
The USPSTF grades PSA screening C for men 55 to 69, meaning an individual decision, and D at 70 and older. The benefits and harms are both real and both measurable.
The USPSTF gives PSA screening a Grade C for men aged 55 to 69, meaning it should be offered selectively after a discussion, and a Grade D for men 70 and older.
Per 1,000 men screened over about 13 years, screening prevents roughly 1.3 prostate cancer deaths and about 3 cases of metastatic prostate cancer.
NCI says about 6 to 7 percent of men have a false-positive PSA on any screening round, and only about 25 percent of men biopsied for a high PSA have cancer. USPSTF estimates about 2 per 1,000 men screened need hospital care for a biopsy complication.
An estimated 20 to 50 percent of prostate cancers found by screening may be overdiagnosed, meaning they would never have caused symptoms.
On this page
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The whole article, with every detail and caution.
What the test is
This page lays out what PSA screening can and cannot do, with the benefits and harms side by side, to help you prepare for a talk with your doctor.
PSA is a protein made by the prostate and measured with a blood draw. Prostate cancer can raise it. So can benign prostatic hyperplasia (an enlarged prostate that is not cancer), prostatitis (swelling or infection of the prostate), a recent biopsy, ejaculation, vigorous cycling, and getting older. PSA is a signal that something is going on in the prostate, not a cancer test.
That uncertainty is the source of nearly every difficulty that follows.
What the USPSTF actually says
The U.S. Preventive Services Task Force (USPSTF) makes two recommendations, not one.
Ages 55 to 69: Grade C. The Task Force recommends that the decision be an individual one, made after a clinician discusses the benefits and harms. A C means the choice is individual.
Ages 70 and older: Grade D. The Task Force recommends against routine PSA screening, having concluded the harms outweigh the benefits at that age.
The benefits, per 1,000 men
Over approximately 13 years of follow-up, for every 1,000 men screened:
- About 1.3 deaths from prostate cancer are prevented.
- About 3 cases of metastatic prostate cancer are prevented.
Metastatic cancer has spread beyond the prostate.
These are small numbers.
The harms, in the same units
False positives. NCI says about 6 to 7 percent of men have a false-positive PSA on any screening round, and only about 25 percent of men biopsied for a high PSA are found to have cancer.
Biopsy complications. USPSTF estimates about 2 per 1,000 men screened need hospital care for a biopsy complication. NCI lists fever, pain, blood in the urine or semen, and urinary tract infection as biopsy risks.
Overdiagnosis. An estimated 20 to 50 percent of prostate cancers detected by screening may be overdiagnosed. Overdiagnosis means finding a cancer that would never have caused harm. The cancer is real, but it would not have caused symptoms.
Treatment side effects. These are the numbers most worth thinking about:
- After radical prostatectomy (surgery to remove the whole prostate), about 1 in 5 men develop long-term urinary incontinence.
- After radical prostatectomy, about 2 in 3 men develop long-term erectile dysfunction.
- After radiation, up to 1 in 6 men have long-term bothersome bowel symptoms.
These effects can be long lasting, and they can affect men whose cancers would never have caused harm.
What has changed, and why the grade moved
In 2012 the USPSTF gave PSA screening a D for all ages. In 2018 it revised that to a C for men 55 to 69 while keeping the D at 70 and older.
USPSTF says the change reflects longer follow-up of the European trial (ERSPC) and more data on metastatic disease prevented. It notes the harms remain substantial. Active surveillance (watching a cancer closely instead of treating it right away) is an option for some low-risk cancers; ask your team.
Who has more at stake
Risk is not the same for everyone. NCI says prostate cancer occurs more often in Black men than in White men. The American Cancer Society also sets earlier ages for men with a close relative diagnosed young.
The American Cancer Society frames this as when to start the conversation. It says 50 for men at average risk with at least 10 years of life expectancy. It says 45 for men at higher risk including Black men and those with a first-degree relative (father, brother or son) diagnosed before 65. And it says 40 for men with several affected first-degree relatives diagnosed young.
Talk with your doctor about how your own risk affects the choice.
Making the decision
There is no answer that is right for everyone in the 55 to 69 band, which is the point of a Grade C. What helps is deciding in advance, before the blood draw, what you would do with each possible result. If your PSA came back high, would you want an MRI? If a low-risk cancer were found, would you accept active surveillance, or would you want it treated?
Answering those questions first turns PSA from a test that makes decisions for you into one that informs decisions you have already thought through.
Sources
Common questions
Should I get a PSA test or not?
For men aged 55 to 69, there is no single right answer, and that is precisely what a Grade C means. The numbers are small on both sides: about 1.3 prostate cancer deaths prevented per 1,000 men over 13 years, against a meaningful chance of a false positive, a biopsy, an overdiagnosed cancer, and treatment side effects. Men who weight avoiding a cancer death very heavily reasonably choose to screen. Men who weight avoiding incontinence, erectile dysfunction, and unnecessary treatment heavily reasonably choose not to. Both are informed choices.
Why does the USPSTF recommend against PSA testing at 70 and older?
USPSTF gives a Grade D at 70 and older, meaning it recommends against screening. Its summary weighs the small benefit against the harms of false positives, biopsy, overdiagnosis and treatment side effects. Talk with your doctor if you are 70 or older and have questions about your own case.
My PSA is elevated. Does that mean I have cancer?
Usually not. PSA can rise with benign prostatic hyperplasia, prostatitis, infection or inflammation of the prostate, a recent biopsy, ejaculation, vigorous cycling, and age. NCI says about 6 to 7 percent of men have a false-positive PSA on any screening round. Your doctor decides the next steps, which may include a repeat test, imaging or a biopsy.
If cancer is found, do I have to be treated immediately?
Not always. Some low-risk prostate cancers can be watched with active surveillance, meaning regular tests with treatment held back unless the cancer changes. This page could not confirm the details of surveillance in an approved source, so ask your team whether it is an option for you.
I am Black, or my father had prostate cancer. Does that change things?
It may mean having the conversation earlier. NCI says prostate cancer occurs more often in Black men than in White men. The American Cancer Society suggests the discussion begin at 45 for Black men and men with a father or brother diagnosed before 65, and at 40 for men with several first-degree relatives diagnosed young.
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Written by: Cancer ExplainedSources last checked: 2026-07-30 what this meansLast updated: 2026-10-02Next planned review: 2027-01-30
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Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes, and this is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and then compared with the sources listed on it, looking for statements those sources do not back up. That check is not a sentence-by-sentence record and can miss errors. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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