Prostate cancer is Australia’s most common cancer and it is the second-biggest cause of cancer death in men. Early detection of prostate cancer is important, but it’s not always straight forward.
New national guidelines for prostate cancer testing aim to find the dangerous cancers while treating fewer harmless ones. Approved by the National Health and Medical Research Council in May 2026, they replace guidelines that had been in place since 2016. Here’s what PSA testing involves, what’s changed, and what you should talk through with your doctor before you have the test.
What has changed in the new prostate cancer testing guidelines?
The guidelines cover the whole early detection pathway. The main changes are:
Specific guidance for men at higher risk of prostate cancer, e.g., family history of prostate cancer, Black males with sub-Saharan African ancestry, certain genetic mutations.
What is PSA testing?
Prostate specific antigen (PSA) is a protein made mainly by cells in the prostate gland. Its job is to reduce how thick the semen is after ejaculation so sperm can move more easily. Most PSA ends up in seminal fluid, but a small amount passes into your blood. A PSA test measures how much is there. A raised PSA does not automatically mean cancer. Your level can go up if your prostate is inflamed or enlarged, or if physical pressure has been applied to it, for example, compression during a long bike ride.
Why did PSA testing need new guidelines?
Blood tests to measure PSA have been used to detect prostate cancer since the 1990s. Before PSA testing, one in every two to three men diagnosed with prostate cancer died of the disease. After PSA testing began, diagnosis rates increased and the death rate from prostate cancer fell. Unfortunately, PSA testing also led to overdiagnosis. Many men who had slow-growing and low-risk prostate cancer, that would never have affected them, underwent unnecessary procedures that caused psychological and physical harms like erectile dysfunction and incontinence, that caused substantial, permanent reductions in their quality of life.
The new guidelines are designed to find more of the cancers that matter while putting fewer men through investigation and treatment they will not benefit from. The guidelines emphasise the need for doctors to discuss risk factors for prostate cancer, and the possible benefits and harms of PSA testing, before testing is done.
When should you have a PSA test?
Before you decide either way, your GP should talk you through your own risk factors and the benefits and harms of testing. That conversation is part of the guidelines, not an optional extra.
If you decide to test, this is what the guidelines recommend.
If you’re aged 45 to 49
Routine testing is not recommended unless you are at higher-than-normal risk. If prostate health is on your mind, your GP may offer you a first test. A result under 1.0 µg/L means you would not usually need testing again until 50.
If you’re aged 50 to 69
Testing every two years is recommended, after a conversation with your GP. If your result stays under 3.0 µg/L, you keep testing on that two-year cycle.
If you’re aged 70 or older
There is no age cut-off. Your GP will weigh up your life expectancy, other health conditions and what matters to you. Testing is generally offered where life expectancy is more than seven years. Under the guidelines, the action level at this age is 5.5 µg/L.
Are you at higher risk of prostate cancer?
You may be at around twice the usual risk if you have:
If any of these apply, the guidelines recommend testing every two years from age 45, with action levels of 1.0 µg/L from 45 to 49, 2.0 µg/L from 50 to 69, and 5.5 µg/L from 70.
What happens after a high PSA result?
A positive result on a PSA test is not the same as a diagnosis of prostate cancer. If you have a positive result (a PSA concentration in your blood that is above a certain age- or other risk-factor-related level) on one test, the test is repeated on another blood sample to confirm the first result, because PSA values can move around a bit.
If you have a confirmed ‘positive’ result, you’ll be referred to a specialist who will direct further diagnosis and management.
Most people with a positive PSA test result have a ‘multiparametric’ MRI scan to find regions of the prostate that might have clinically significant cancer. Sometimes the MRI can rule out the need for further investigations. If clinically significant cancer seems likely based on the MRI, biopsies (small samples of tissue collected using needles) are collected from the prostate, based on where the MRI detected possible cancer. These biopsies are then examined in a laboratory to look for cancerous cells. It’s not until the biopsies are analysed that cancer is diagnosed.
Prostate cancer treatment
Curing prostate cancer with surgery or radiation treatment comes with risk of complications including sexual dysfunction and incontinence. If prostate cancer has spread to other parts of the body, control using chemotherapy, hormone treatments or other medications may be used.
Many people with low-grade prostate cancer will not require treatment straight away and may be managed using ‘active surveillance’, which involves regular PSA tests and MRI scans and might include later biopsies. The goal of active surveillance is to avoid harms from treatment without threatening survival by timing treatment to when it is needed.
We have come a long way since the first uses of PSA testing for detecting prostate cancer. Now PSA testing algorithms, coupled with MRI, are avoiding harms from unnecessary biopsies and treatment, resulting in high quality of life for longer in people with prostate cancer.
The guidelines are national recommendations, not a set of rules about you specifically. If you are unsure whether testing is right for you, that is a conversation to have with your GP.
People also ask
What are the 5 early warning signs of prostate cancer?
Early prostate cancer usually has no warning signs. Symptoms tend to appear only once the cancer is more advanced, which is why testing is based on your age and risk rather than how you feel.
When symptoms do occur, they can include:
– Needing to urinate more often, particularly at night
– Trouble starting or stopping the flow of urine
– A weak or slow stream
– Pain or burning when you urinate or ejaculate
– Blood in your urine or semen
Most of these are more likely to be caused by an enlarged prostate, which is common as you get older and is not cancer. Even so, they are worth seeing your GP about. Pain in your lower back, hips or pelvis that has no obvious cause is also worth checking.
What tests are done to confirm prostate cancer?
Only a biopsy can confirm prostate cancer. Before that, a PSA blood test is repeated to check a high result, and an MRI scan looks for areas of the prostate that might contain significant cancer, which sometimes means a biopsy can be avoided.
At what age should I start getting my prostate checked for cancer?
For most men, PSA testing is recommended every two years from age 50 to 69, after a conversation with your GP. If you are at higher risk, because of family history, Black sub-Saharan African ancestry or a BRCA2 gene mutation, testing is recommended every two years from 45. There is no upper age cut-off, so from 70 your GP will weigh up your general health and what matters to you.
Can I perform a self-exam for prostate cancer?
No. Unlike testicular cancer, there is no self-exam for prostate cancer. The prostate sits deep inside your pelvis, below the bladder, so you cannot feel it yourself. Checking for prostate cancer involves a PSA blood test through your GP.
