PSA Testing: The Updated 2026 Australian Guidelines
The Australian guidelines for prostate cancer early detection have been updated for the first time since 2016. The new guidelines take a more risk-based and individualised approach to PSA testing, with the aim of detecting clinically significant prostate cancer earlier while reducing unnecessary investigations and treatment.
Who should consider PSA testing?
PSA testing should follow a discussion between the man and his doctor about the potential benefits and limitations of testing.
Men aged 50–69
For men at average risk who choose PSA testing:
PSA testing is recommended every 2 years.
A PSA below 3.0 µg/L generally supports continuing testing every 2 years.
A PSA of 3.0 µg/L or higher should generally be repeated within 1–3 months.
If the elevated PSA is confirmed, referral for further assessment should be considered.
Men aged 45–49
Routine PSA testing is not recommended for all men in this age group, although an initial PSA test may be offered following discussion with a doctor.
PSA <1.0 µg/L: generally no further testing until age 50.
PSA ≥1.0 µg/L: repeat PSA within 1–3 months and consider specialist referral if the elevation persists.
Men at increased risk
Men with certain risk factors should consider starting PSA testing earlier.
Higher-risk groups include men with:
a brother diagnosed with prostate cancer;
a father diagnosed before age 65;
two or more second-degree relatives who died from prostate cancer;
Black sub-Saharan African ancestry; or
a known BRCA2 mutation.
For these men, PSA testing is recommended every 2 years from age 45, with lower PSA thresholds prompting further assessment.
Men aged 70 and older
There is no longer a simple age-based recommendation to automatically stop PSA testing.
Testing should be individualised according to factors including:
life expectancy;
overall health;
other medical conditions;
individual prostate cancer risk; and
the patient's preferences.
Testing is generally considered appropriate where life expectancy is greater than 7 years.
What if the PSA is elevated?
An elevated PSA does not necessarily mean prostate cancer. PSA can be increased by a number of benign conditions, including prostate enlargement and inflammation.
The new guidelines recommend confirming an elevated PSA with repeat testing before proceeding to further investigation in appropriate patients.
If the PSA remains elevated, the patient should generally be referred for further assessment.
MRI before prostate biopsy
One of the major changes in the 2026 guidelines is the increased role of multiparametric MRI (mpMRI).
Where prostate cancer is suspected, mpMRI is recommended before prostate biopsy. MRI can identify areas suspicious for clinically significant cancer and help determine whether a biopsy is required and where it should be targeted.
What about a digital rectal examination?
Routine digital rectal examination is no longer recommended as part of PSA screening in primary care.
However, examination may still have a role in the assessment of an individual patient, particularly during specialist evaluation.
The key message
Prostate cancer risk should be assessed using a combination of:
Age + family history + genetic risk + PSA + MRI + individual clinical factors
The aim is to identify clinically significant prostate cancer early, while reducing unnecessary biopsies, overdiagnosis and overtreatment.
If you have concerns about your PSA or your risk of prostate cancer, discuss your individual circumstances with your GP or urologist.
This information is intended as a general guide and does not replace individual medical assessment.
