PSA test by age: prostate cancer screening advice

USPSTF prostate cancer screening recommendation by age
Age	USPSTF says	Grade
Under 55	No recommendation for this age group. The USPSTF found "inadequate evidence to assess whether there are benefits to starting screening" before 55 in higher-risk groups.	None
55 to 69	"The decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one."	C
70 and older	"The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older."	D

The USPSTF lists an update in progress for this topic; on 2026-10-27 it had not published a new final statement. Until it does, this page follows the final May 8, 2018 recommendation. (USPSTF)

Why it is "your decision" and not a routine test

A grade C means the USPSTF found a small net benefit for some people, so the choice depends on the person. For prostate cancer, it puts it this way: "Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening." (USPSTF, 2018)

That is also why this site's screening planner does not add it automatically: the planner lists grade A and B screenings only. See Method.

The benefits, in numbers

From the randomized trials the USPSTF reviewed, for men 55 to 69: (USPSTF, 2018)

PSA-based screening programs "may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened."
They "may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened."
"Current results from screening trials show no reductions in all-cause mortality from screening."

The harms the USPSTF lists

"False-positive results that require additional testing and possible prostate biopsy."
"Overdiagnosis and overtreatment": finding cancers that would never have caused problems, then treating them.
"Treatment complications, such as incontinence and erectile dysfunction."

For men 70 and older, the USPSTF adds that "harms are greater." (USPSTF, 2018)

PSA after 70

The USPSTF recommends against PSA-based screening for men 70 and older (grade D), and says clinicians "should not routinely screen men 70 years and older." (USPSTF, 2018)

Less benefit. The large screening trials "did not report a mortality benefit for men older than 70 years." (USPSTF, 2018)
More harm. "The false-positive and complication rates from biopsy are higher in older men," and overdiagnosis is expected "to be highest in men 70 years and older because older men have high risk of death from competing causes." (USPSTF, 2018)
Some men still test. The USPSTF "understands that some older men will continue to request screening and some clinicians will continue to offer it." Men older than 70 who ask "should be aware of the reduced likelihood of benefit from screening and the increased risk of false-positive test results and complications of diagnosis and treatment." (USPSTF, 2018)
What stopping means. The recommendation is about men "without symptoms or a previous diagnosis of prostate cancer." (USPSTF, 2018) If you have urinary symptoms, or are being followed for prostate cancer, that is a different conversation; talk to your doctor.

Medicare still covers a yearly PSA test for men over 50 (Medicare.gov), so a test after 70 can be covered even though it is not recommended. Turning 70 is a good time to ask your doctor whether to keep testing.

If you are at higher risk

"Older age, African American race, and family history of prostate cancer are the most important risk factors." The recommendation applies to these men too, but the USPSTF found "inadequate evidence to assess whether the benefits for African American men and men with a family history of prostate cancer aged 55 to 69 years are different than the benefits for the average-risk population," and the same for starting before 55. (USPSTF, 2018) If either applies to you, raise it with your doctor earlier rather than later.

What the PSA test is

PSA is "a protein produced by normal, as well as malignant, cells of the prostate gland." Prostate cancer can raise it, and so can benign conditions, "particularly benign prostatic hyperplasia, or BPH, and prostatitis." (NCI)

No single normal value. "There is no single threshold that distinguishes a normal versus an abnormal PSA result." In general, "a PSA level above 4.0 ng/mL is considered abnormal and may result in a recommendation for prostate biopsy." Some doctors use a higher cutoff (such as 5) for older men and a lower one (such as 2.5) for younger men. (NCI)
Things that raise it for a while. Infection or inflammation of the prostate, or a recent biopsy, can raise PSA "for a month or two." Vigorous exercise such as cycling, and ejaculation, can raise it briefly. (NCI)
Medicines that lower it. Finasteride and dutasteride, used for BPH, lower PSA, so a lower cutoff is used for men taking them. (NCI) Tell your doctor if you take either.

The digital rectal exam is not a recommended screening test: the USPSTF says it "is not recommended because there is a lack of evidence on the benefits." (USPSTF, 2018)

What Medicare covers

Medicare Part B covers a PSA blood test and a digital rectal exam once every 12 months for men over 50 (from the day after the 50th birthday). You pay nothing for the PSA test itself; for the rectal exam you pay 20% of the Medicare-approved amount after the Part B deductible. (Medicare.gov) Coverage is broader than the USPSTF advice, so a covered test is not the same as a recommended one. More on preventive screenings covered by insurance and Medicare.

Questions to bring to your doctor

Given my age, family history and health, how much could screening help me?
If my PSA comes back high, what happens next, and how likely is a biopsy?
If a cancer is found, would active surveillance be an option?
How often would we repeat the test?

Questions people ask

At what age should men get a PSA test?

The USPSTF does not set a start age for everyone. For men 55 to 69, it says the decision to be screened "should be an individual one," made after talking through benefits and harms with a clinician (grade C). It recommends against PSA screening at 70 and older (grade D).

At what age do you stop prostate cancer screening?

The USPSTF recommends against PSA-based screening for men 70 and older, and says harms are greater in that age group.

Is a PSA test part of a routine physical?

Not automatically. Because the USPSTF grade is C, it is a test to decide on with your doctor, not one that every man should get. Ask about it if you are 55 to 69.

Should men over 70 get a PSA test?

The USPSTF recommends against routine PSA screening from 70 (grade D). It also says some older men will still ask for the test and some clinicians will offer it; men over 70 who ask should know the chance of benefit is lower and the risk of false positives and treatment complications is higher.

Why does the USPSTF advise against PSA screening after 70?

The large screening trials it reviewed did not report a lower death rate for men older than 70, and the harms grow with age: biopsy complications and false positives are more common in older men, and overdiagnosis is expected to be highest at 70 and older because of the higher risk of dying from other causes.

What does stopping PSA screening at 70 mean?

It means no routine PSA test for men without symptoms. It does not cover men who have urinary or other symptoms, or who have already been diagnosed with prostate cancer; they should talk to their doctor about their care.

Does Medicare still cover a PSA test after 70?

Medicare Part B covers a PSA blood test once every 12 months for men over 50. Being covered is not the same as being recommended, so decide with your doctor.

What is a normal PSA level?

The National Cancer Institute says there is "no single threshold" for normal. In general, a level above 4.0 ng/mL is considered abnormal and may lead to a biopsy recommendation, but some doctors use different cutoffs by age.

Does Medicare cover PSA tests?

Yes. Medicare Part B covers a PSA blood test once every 12 months for men over 50, and you pay nothing for the test itself. A digital rectal exam is covered too, with 20% coinsurance after the deductible.

Prostate cancer screening (PSA) by age