Prostate cancer is the most commonly diagnosed cancer in men in the United States, after skin cancer, and about 1 in 8 men will be diagnosed with it during their lifetime.¹ Yet many men are unsure when they should start getting screened, or whether they need to be screened at all.
That confusion is understandable. Unlike some cancer screenings, there is no single, universal recommendation. Prostate cancer screening guidelines depend heavily on your age, your race, and your family history, which means the right starting point looks different from person to person.
This guide breaks down the current prostate cancer screening guidelines, what the PSA test and digital rectal exam actually involve, what insurance and Medicare cover, and the exact steps to take to start the conversation with your doctor.
Why Prostate Cancer Screening Guidelines Matter
Prostate cancer often grows slowly, and many men with it never experience symptoms.² Without screening, it can go undetected until it has spread. But because prostate cancer can also be slow-moving enough that some men never need treatment for it in their lifetime, screening decisions involve weighing real benefits against real risks, including overdiagnosis and overtreatment.²
This is why prostate cancer screening guidelines emphasize an informed, personal conversation with your doctor rather than a one-size-fits-all rule.
Prostate Cancer Screening Guidelines: When Should Men Get Screened
The American Cancer Society (ACS) recommends men have a conversation with their doctor about the benefits and risks of screening starting at:³
- Age 50 for men at average risk, who are expected to live at least 10 more years
- Age 45 for men at high risk, including Black men and men with a first-degree relative (father or brother) diagnosed with prostate cancer before age 65
- Age 40 for men at even higher risk, meaning more than one first-degree relative diagnosed before age 65
The U.S. Preventive Services Task Force (USPSTF) has separately recommended that men ages 55 to 69 make an individual decision about PSA screening with their doctor, and has advised against routine screening for men 70 and older, since prostate cancer risk must be weighed against life expectancy and treatment risks at older ages.⁴
Note: Screening recommendations for older adults are actively being reevaluated by some medical groups, so it’s worth confirming the latest guidance with your doctor.
Race is one of the most significant risk factors. Black men are about 70% more likely to be diagnosed with prostate cancer than white men, and more than twice as likely to die from it, which is why guidelines call for starting the conversation earlier.⁵
What a Prostate Cancer Screening Involves: The PSA Test and Digital Rectal Exam
Prostate cancer screening typically involves two tools, and your doctor may use one or both:⁶
- PSA (prostate-specific antigen) test: A simple blood test that measures a protein made by the prostate. Elevated PSA levels can be a sign of prostate cancer, but can also be caused by non-cancerous conditions like an enlarged or inflamed prostate.
- Digital rectal exam (DRE): A brief physical exam where a doctor checks the prostate for irregularities. It typically takes less than a minute.
Neither test alone confirms cancer. If results are abnormal, your doctor will talk with you about next steps, which may include additional testing like an MRI or biopsy.
What Insurance May Cover for Prostate Cancer Screening
Many states require private health insurers to cover PSA testing and digital rectal exams for prostate cancer screening.⁷ Most state laws require this coverage for men age 50 and older, and for high-risk men starting at age 40, though exact requirements vary by state.⁷
Because coverage rules differ, it’s worth confirming your specific plan’s requirements directly with your insurer or your state insurance commissioner’s office.
Medicare Prostate Cancer Screening Coverage
Medicare Part B covers one PSA blood test every 12 months at no cost for men age 50 and older, with no copay and no Part B deductible, as long as your provider accepts assignment.⁸
Medicare also covers one digital rectal exam every 12 months for men 50 and older, though unlike the PSA test, the DRE is subject to the Part B deductible and 20% coinsurance.⁹
|
Test
|
Frequency
|
Cost Under Medicare
|
|---|---|---|
|
PSA blood test |
Every 12 months, age 50+ |
$0 (no deductible) |
|
Digital rectal exam |
Every 12 months, age 50+ |
Subject to Part B deductible + 20% coinsurance |
|
Follow-up MRI or biopsy |
If medically necessary |
Billed as diagnostic care, subject to deductible + coinsurance |
Medicare Advantage plans are required to cover at least as much as Original Medicare, though it’s worth confirming your specific plan’s network and cost-sharing details.⁹
6 Steps to Get Screened While Getting Insurance Support
Step 1: Know Your Personal Risk Factors Note your age, race, and any family history of prostate cancer, including which relatives were diagnosed and at what age. This determines which screening guideline applies to you.
Step 2: Start the Conversation With Your Doctor Tell your doctor you want to discuss prostate cancer screening. Bring your risk factors so they can help you weigh the benefits and risks of testing.
Step 3: Confirm Your Insurance Type Check whether you have private insurance, Medicare, or Medicaid. Your insurance card should have a member services number on the back.
Step 4: Ask About Coverage By Name When you call your insurance plan, ask:
- “Is an annual PSA test and digital rectal exam covered under my plan?”
- “Do I need a referral or prior authorization?”
- “Is there a copay for either test?”
Step 5: Schedule Your Screening Once you understand your coverage, schedule your PSA test and/or DRE with your doctor’s office or find screening locations.
Step 6: Understand Your Results and Next Steps Ask your doctor to explain your results clearly, including what would happen next if your PSA level is elevated or your DRE result is abnormal.
Self-Advocacy Language For Readers
If you want your insurance to help cover prostate cancer screening, or want to make sure your risk factors are part of the conversation, try using these words:
- “Based on my age and family history, when should I start getting screened for prostate cancer?”
- “I’m Black, and I understand that changes when I should start this conversation. Can we talk about that?”
- “Can you walk me through what the PSA test and exam actually involve?”
- “Is my annual PSA test and digital rectal exam covered under my plan?”
- “My PSA came back elevated. What does that mean, and what happens next?”
Frequently Asked Questions
Q: At what age should men start prostate cancer screening?
A: The American Cancer Society recommends starting the screening conversation at age 50 for average-risk men, age 45 for high-risk men including Black men, and age 40 for men with more than one close relative diagnosed with prostate cancer before age 65.
Q: What does a prostate cancer screening involve?
A: Screening typically includes a PSA blood test and sometimes a digital rectal exam. Neither test alone confirms cancer; abnormal results lead to a conversation about further testing.
Q: Does Medicare cover prostate cancer screening?
A: Yes. Medicare Part B covers one PSA blood test every 12 months at no cost for men 50 and older. It also covers one annual digital rectal exam, though this is subject to the Part B deductible and 20% coinsurance.
Q: Why do Black men need to start screening earlier?
A: Black men are about 70% more likely to be diagnosed with prostate cancer and more than twice as likely to die from it compared to white men, which is why guidelines recommend starting the screening conversation at age 45 instead of 50.
Q: Does an elevated PSA mean I have cancer?
A: Not necessarily. PSA levels can be elevated due to non-cancerous conditions like an enlarged or inflamed prostate. Your doctor can help interpret your results and determine appropriate next steps.
References
- American Cancer Society. (2024, January 17). Key Statistics for Prostate Cancer. Retrieved from American Cancer Society: https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html
- U.S. Preventive Services Task Force. (2018, May 8). Prostate Cancer: Screening. Retrieved from USPSTF: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening
- American Cancer Society. (2023, November 22). American Cancer Society Recommendations for Prostate Cancer Early Detection. Retrieved from American Cancer Society: https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/acs-recommendations.html
- American Cancer Society. (2024, January 17). Tests to Diagnose and Stage Prostate Cancer. Retrieved from American Cancer Society: https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html
- American Cancer Society. (2026, June 11). Insurance Coverage for Prostate Cancer Screening. Retrieved from American Cancer Society: https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/insurance-coverage.html
- UnitedHealthcare. (2025). Medicare Coverage for Prostate Cancer Screening. Retrieved from UnitedHealthcare: https://www.uhc.com/news-articles/medicare-articles/medicare-coverage-for-prostate-cancer-screening
- Medicare Interactive. (2025, March 31). Prostate Cancer Screenings. Retrieved from Medicare Interactive: https://www.medicareinteractive.org/understanding-medicare/medicare-covered-services/preventive-services/prostate-cancer-screenings
