Who Should Get a PSA Test?

Some recommendations say men don’t need one after 70, but many doctors encourage older patients to discuss the decision with their doctor

Kristen Fischer,

AARP

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Published May 29, 2025

Prostate-specific antigen test, conceptual image

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As is the case for many cancer screenings, recommendations on who should get the test that can detect prostate cancer, known as the prostate-specific antigen (PSA) blood test, can become a bit of a gray area once you hit a certain age.

The United States Preventive Services Task Force (USPSTF), which publishes guidelines on medical practices, says that most men do not need the test after age 70. However, guidelines from other expert groups aren’t as clear with their age cutoff, and many doctors say that a man’s overall health status should also be considered when making screening decisions. This can be confusing for older adults who want to be proactive about their health and are used to more testing as they age.

There are merits and drawbacks to the PSA test, and “that’s for any age,” says Michael J. Morris, M.D., an oncologist at Memorial Sloan Kettering Cancer Center.

Know Your Prostate Cancer Risk

You may have a higher risk for prostate cancer and be a candidate for PSA testing if you are:

Older. About 6 in 10 prostate cancers are found in men who are age 65 and up. The average age of men at diagnosis is 67.
African American or Caribbean. If you’re African American or a Caribbean man with African ancestry, you have a higher risk for prostate cancer.
Related to someone with it. Your risk is higher if a relative has had cancer, especially one diagnosed with prostate cancer before age 55.

While a PSA screens for aggressive forms of prostate cancer that warrant prompt care, it can also lead those with no cancer or nonaggressive forms of the disease to unnecessary testing and overtreatment. For example, prostate biopsies can result in infections and trouble urinating, and prostate cancer treatments can cause urinary, bowel and sexual issues, which may not be worth the risk for men who have a slow-growing cancer that’s unlikely to spread.

“One of the reasons why this is such as tricky topic is because prostate cancer is so ubiquitous,” says Mark M. Pomerantz, M.D., an oncologist at the Dana-Farber Cancer Institute. Many men in their 70s and 80s will have a nonaggressive form of the disease that won’t cause symptoms or threaten their lives because it grows so slowly, he says.

“If we go snooping around with PSA tests and subsequent imaging studies and then biopsies, we’re going to find a lot of prostate cancer because most [older] people have it,” Pomerantz explains. They’ll die with it but not of it, he adds.

The PSA test: What it measures, what it doesn’t

The PSA test measures a protein in the blood that can signal prostate cancer. It is not a definitive diagnosis; you’ll need more testing to confirm if an elevated PSA is from cancer, as increased PSA levels can also indicate an enlarged prostate or a urinary tract infection.

Some people have lower PSA levels but have aggressive prostate cancer, while others may have higher PSA levels and either no cancer or a form of the disease that’s much less fast-growing and doesn’t need to be treated. The test can’t tell the difference, Pomerantz says.

“Once you have that elevated PSA, now you’ve triggered those downstream tests. And that’s where the dilemma comes from,” says Bilal A. Siddiqui, M.D., a medical oncologist at the University of Texas MD Anderson Cancer Center.

To assess your prostate cancer risk relative to the PSA test, doctors look at PSA levels that are elevated and continue to rise over time. Keep in mind that PSA levels usually go up as you age.

Making sense of PSA screening guidelines

Several organizations have guidelines about who should get tested and when. And, Siddiqui admits, “the guidelines for this are confusing.”

The American Cancer Society (ACS) recommends PSA tests starting at age 50 for men who are at average risk for prostate cancer and are expected to live for at least 10 more years. Men who are age 45 and are African American, or individuals who have a first-degree family member who had prostate cancer before turning 65, should also get tested. The ACS recommends testing in men starting at 40 if they have more than one first-degree relative who had the disease at an early age. The ACS says some men need testing only every two years, while men with higher levels should have another test done every year.
The USPSTF says men ages 55 to 69 should undergo testing based on individual counseling.
The American Urological Association (AUA) recommends a first prostate cancer screening between the ages of 45 and 50 and as early as 40 for those with a higher risk. The AUA recommends regular screening for those 50 to 69 every two to four years.

What about when you ring in your 70th? Though USPSTF guidelines recommend against PSA testing over the age of 70 for many men, Pomerantz encourages men 70-plus to talk with their doctors about the risks and benefits of continued screening. “All men with a life expectancy of over 10 years should be discussing PSA screening with their doctor” no matter their age, he says.

“It’s just really important for men to get the message that there is a group of men that need to be screened for prostate cancer, and they really should be having that conversation with their doctor,” Siddiqui says.

What happens after a PSA test

After an elevated PSA test, your doctor may request another PSA test to confirm the results, Siddiqui says.

At that point, additional blood and urine tests can spot biomarkers that may give a better indication if cancer is present, says Michael S. Leapman, M.D., a urologic oncologist at Yale Medicine. “They’re pretty good about ruling out prostate cancer,” he says.

Biomarker tests may show that you don’t need the next step: a magnetic resonance imaging (MRI) scan. The specialized MRI lets doctors see spots on the prostate that could be suspicious. If there are none, the doctor may not request a biopsy, Leapman says. “Many men can be spared a biopsy, which ultimately diagnoses the disease, if we use MRI in that way,” he adds.

About two-thirds of men don’t receive an MRI prior to a biopsy, Leapman says. That could be due to poor health care access, insurance issues or a doctor not knowing how valuable an MRI can be to determining the need for a biopsy, Leapman says. “There’s a lot that can be done before going straight from a PSA to biopsy,” he adds.

Prostate cancer … now what?

Upon a cancer diagnosis, some people want to treat it right away. But prostate cancer is different from other forms of cancer, which is why the choice to have a PSA test — and what to do with the results — must be individualized, Siddiqui says.

The majority of prostate cancers aren’t aggressive, and most prostate cancer cases don’t require treatment, Morris says. Men with this type of cancer may have periodic PSA testing or MRI scans to keep tabs on the cancer, Siddiqui says.

More harmful types of prostate cancer, however, demand prompt care. “We do want to catch those aggressive cases as early as possible and get those people cured,” Pomerantz says.

The risks that come from prostate removal surgery and radiation include urinary and sexual issues, which is why doctors are largely conservative if the cancer is not aggressive, Siddiqui says.

If the cancer is only in the prostate, your doctor may talk about removing it, along with radiation. You might also get hormone treatments to lower levels of testosterone, which fuels the cancer, Siddiqui says.

If the prostate cancer has spread to other parts of your body, doctors tend not to remove the prostate and turn to hormonal therapy, Morris says. People may get chemotherapy and/or radiation as well, but intensified hormonal therapy is more common, Siddiqui says.

Cancer that has spread outside of the prostate is very treatable, Morris says. “Prostate cancer is one of the most eminently treatable diseases of all cancers,” he adds.

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Kristen Fischer is a contributing writer at AARP based at the Jersey Shore. She has also written for Health, WebMD, and McKnights and is the author of Zoo Zen: A Yoga Story for Kids.