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Why is prostate cancer screening controversial?

A woman hugs a man from behind.

June 8, 2026—Screening might help protect men from prostate cancer, one of the most common cancers in men. But it isn't universally recommended. Instead, men are usually advised to weigh the pros and cons before they decide whether or not to be screened.

So why is that? The main way to screen for prostate cancer is with the prostate-specific antigen (PSA) test, which looks for elevated levels of PSA in the blood. Like all screening tests, the PSA test has possible risks and benefits. And experts say it isn't clear if the benefits outweigh the risks.

The benefits of PSA testing are clear: Screening can find high-risk prostate cancer early. Some prostate cancers can be aggressive and grow quickly. Finding these cancers before they spread may lead to lifesaving treatment for some men, the Centers for Disease Control and Prevention (CDC) notes. Every year, many men die from prostate cancer.

But testing does come with risks, including:

Detecting cancers that may not need treatment. Most prostate cancers grow slowly, CDC reports. They may not ever cause problems or become dangerous in a man's lifetime. But if prostate cancer is found through screening, a man may choose to treat it. And prostate cancer treatment can have significant side effects, such as erectile dysfunction and urinary incontinence.

False positives and unnecessary testing. Conditions other than prostate cancer can cause an elevated PSA level. Some examples are:

  • Benign prostatic hyperplasia, commonly called an enlarged prostate.
  • Prostate infections.
  • Simply getting older.

A positive test result could lead to more tests, like a prostate biopsy. This can cause anxiety and expose men to additional risks.

Recent review: Screening prevents some deaths

Researchers continue to study prostate cancer screening. Cochrane looked at six large European and U.S. prostate cancer screening trials to see if PSA tests are effective at preventing deaths and other negative outcomes.

Previous Cochrane reviews—most recently in 2013—did not find that prostate cancer screening reduced deaths significantly.

This time, their conclusion was different. The 2026 review found that screening probably lowers the chance of dying from prostate cancer, but the benefit is small. For every 1,000 men screened, about two fewer men may die from the disease.

It's a personal choice

Every man should decide for himself whether to get screened for prostate cancer, after talking with his doctor about the pros and cons. Not all medical authorities agree on when men should begin screening, should they choose to do so. The American Cancer Society (ACS) says most men should start:

  • At age 45, if you're at high risk for prostate cancer. You're considered to have a high risk if you are African American or if your father, brother or son was diagnosed with prostate cancer before age 65. If more than one relative was diagnosed at an early age, the ACS recommends starting screening sooner, at age 40.
  • At age 50, if you're at average risk for prostate cancer.

Other groups have different recommendations. The U.S. Preventive Services Task Force says men who are 55 to 69 years old should decide whether to be screened. The group recommends against screening men who are 70 or older because their life expectancy may limit screening's benefits. But many men in this age group have many healthy years ahead of them. If you're in this age group, you should talk to your doctor about what's right for you.

Your doctor can help you learn more about the pros and cons of screening. You might also find our prostate cancer screening assessment helpful as you consider your options.

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