For many years, there has been mixed messaging around PSA testing for prostate cancer. Some men may even remember being told that routine PSA testing was not recommended.
That advice has now changed.
In 2026, Australia released new Clinical Practice Guidelines for the Early Detection of Prostate Cancer, developed by the Prostate Cancer Foundation of Australia, approved by the National Health and Medical Research Council (NHMRC), and endorsed by the Royal Australian College of General Practitioners (RACGP).
The new guidelines recognise that a lot has changed over the past decade. We now have better evidence about PSA testing, much greater use of prostate MRI, more targeted biopsies and active surveillance for many low-risk prostate cancers.
The result is a more proactive but also more individualised approach to finding clinically significant prostate cancer early, while trying to minimise unnecessary investigation and treatment.
What is a PSA test?
PSA stands for prostate-specific antigen. It is a simple blood test that measures a protein produced by the prostate.
A raised PSA does not automatically mean prostate cancer. PSA can also rise because of benign enlargement of the prostate, inflammation and other non-cancerous causes.
However, PSA remains the main first-line test used to identify men who may need further investigation for prostate cancer.
So, when should men start PSA testing?
The new recommendations depend on your age and your individual risk.
Age 50–69: average risk
Men aged 50 to 69 years should be offered the opportunity to have PSA testing after discussing the potential benefits and harms with their GP.
For men who choose testing, the recommendation is:
PSA testing every two years.
For men at average risk, a PSA of 3.0 µg/L (ng/mL) or above should usually be repeated within 1–3 months before further investigation is considered.
Age 45 and over: higher risk
Men at higher risk should start the conversation earlier.
The new guidelines recommend offering PSA testing every two years from age 45 for men considered at higher risk of prostate cancer.
Family history is particularly important.
You may be at increased risk if:
- your brother has been diagnosed with prostate cancer
- your father was diagnosed with prostate cancer, particularly before the age of 65
- you have multiple relatives who have had prostate cancer
- two or more second-degree relatives, such as a grandfather or uncle, have died from prostate cancer.
Other recognised higher-risk groups include men with a BRCA2 gene mutation and Black men of sub-Saharan African ancestry.
If prostate cancer runs in your family, it is worth discussing your personal risk with your GP rather than simply waiting until age 50.
Age 45–49 without a family history
There is also an important new option for men aged 45–49 who are not considered higher risk but are concerned about their prostate health.
An initial PSA test can now be considered after discussion with your GP.
If the PSA is below 1.0 µg/L, further routine testing can usually wait until age 50.
This does not mean that every man needs routine screening from 45, but it gives men who are concerned the option of having an earlier baseline assessment.
What about men over 70?
Age 70 is no longer necessarily an automatic stopping point.
PSA testing may continue every two years in selected men aged 70 and over, depending on their general health, other medical conditions, life expectancy and personal preferences.
The guidelines suggest PSA testing where life expectancy is greater than approximately seven years and where finding prostate cancer would realistically change management.
What happens if your PSA is high?
A high PSA does not mean you will automatically need a prostate biopsy.
One of the major changes in modern prostate cancer investigation is what happens after an abnormal PSA.
An unexpectedly raised PSA will generally be repeated after 1–3 months. If it remains elevated, your GP may refer you to a urologist for further assessment.
Increasingly, the next step is a multiparametric MRI (mpMRI) of the prostate before considering biopsy.
This helps specialists identify men who are more likely to have clinically important prostate cancer while allowing some men to avoid unnecessary biopsy.
Do I still need a prostate examination?
Not necessarily.
The 2026 guidelines suggest that a digital rectal examination is not routinely required in general practice simply because a man is having PSA testing.
It may still form part of a specialist assessment if PSA results or other findings require further investigation.
Why has the advice changed?
Historically, one of the major concerns about PSA testing was overdiagnosis – finding slow-growing prostate cancers that may never have caused harm.
There was also concern that finding these cancers could lead to unnecessary biopsies or treatment, with potential side effects including urinary and sexual problems.
Modern prostate cancer care is very different.
We now have:
- better ways of identifying which men are genuinely at higher risk
- prostate MRI before biopsy
- more targeted biopsy techniques
- better classification of low-risk versus clinically significant cancers
- increasing use of active surveillance rather than immediate treatment for appropriate low-risk prostate cancers.
These changes allow us to focus more strongly on early detection of cancers that matter, while reducing some of the harms that historically accompanied PSA screening.
The important message
Prostate cancer is Australia’s most commonly diagnosed cancer, with around 29,000 Australian men diagnosed each year and close to 4,000 deaths annually.
Early prostate cancer often causes no symptoms, so waiting until urinary symptoms develop is not a reliable way of detecting it early.
The new guidelines do not recommend automatically testing every man. Instead, they encourage men and their GPs to have a conversation about age, family history, individual risk and the potential benefits and harms of testing.
As a simple guide:
45+ with a family history or other significant risk factor: talk to your GP about PSA testing.
45–49 and concerned about your prostate health: an initial PSA can be considered.
50–69: discuss regular PSA testing, generally every two years.
70+: testing may still be appropriate depending on your overall health and circumstances.
If you are unsure when you last had your PSA checked, or whether you should be having regular testing, speak with your GP at your next appointment.
This article provides general health information and does not replace individual medical advice. Your GP can assess your personal risk and discuss whether PSA testing is appropriate for you.