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Updated prostate cancer guidelines: PSA testing, referral and the role of prostate MRI

New national clinical practice guidelines provide updated recommendations for the early detection of prostate cancer in Australia, including a clearer risk-based approach to prostate-specific antigen (PSA) testing and reinforcement of the established role of multiparametric MRI before biopsy.

Published on

02 Sep 2026

Clinically reviewed by Dr Julia Williams, Radiologist, Lumus Imaging.

The 2026 Guidelines for the Early Detection of Prostate Cancer in Australia were developed by the Prostate Cancer Foundation of Australia (PCFA) in partnership with Cancer Council Australia. They replace the previous guidelines released in 2016 and have been approved by the National Health and Medical Research Council.

The updated guidelines reinforce the established role of multiparametric MRI, or mpMRI, in specialist assessment before prostate biopsy. They are intended to support earlier detection of clinically significant prostate cancer while reducing the potential harms associated with unnecessary biopsy, overdiagnosis and overtreatment.

A risk-based approach to PSA testing

PSA is a protein produced by prostate cells. A PSA blood test can help identify people who may require further investigation, but an elevated result does not necessarily indicate prostate cancer.

The updated guidelines outline different testing recommendations according to a person’s age and individual risk.

Men aged 45 to 49

The guidelines do not recommend routine PSA testing for men aged 45 to 49 who are not at higher risk of prostate cancer. However, an initial PSA test may be offered to men in this age group who are interested in their prostate health, following an informed discussion with their GP.

For men aged 45 to 49 who are considered to be at higher risk, the guidelines recommend PSA testing every two years.

Men aged 50 to 69

Following an informed discussion about the potential benefits and harms of testing, the guidelines recommend PSA testing every two years for men aged 50 to 69.

Men aged 70 and over

For men aged 70 and over, the guidelines recommend an individualised approach based on clinical assessment, life expectancy, other health conditions and the person’s values and preferences.

According to PCFA’s guideline summary, testing is generally offered when a person’s life expectancy is greater than seven years.

Identifying men at higher risk

The guidelines recognise that some men have at least twice the usual risk of developing clinically significant prostate cancer.

Higher-risk factors identified by PCFA include:

having a brother who has been diagnosed with prostate cancer
having a father who was diagnosed before the age of 65
having two or more second-degree relatives who died from prostate cancer
having Black sub-Saharan ancestry
having a confirmed BRCA2 gene mutation.

The guidelines recommend two-yearly PSA testing from age 45 for men in these higher-risk groups, with age- and risk-specific PSA action levels.

Healthcare professionals should refer to the complete guidelines for the detailed recommendations applying to each patient group.

What happens when a PSA result is elevated?

An elevated PSA result does not confirm a diagnosis of prostate cancer. PSA levels can be affected by several cancerous and non-cancerous factors.

The updated guidelines outline a pathway in which a PSA result at or above the relevant action level is generally repeated within one to three months. If the result remains elevated, the GP may consider referral to a specialist for further assessment.

The pathway described in the guidelines may include:

Individual risk assessment and informed discussion → PSA testing → repeat testing following an elevated result → specialist referral → multiparametric MRI → biopsy where indicated

Each step depends on the person’s individual circumstances, and the complete guidelines should be consulted when making clinical decisions.

The guidelines also advise that digital rectal examination is no longer routinely recommended as an addition to PSA testing in primary care. It may still have a role in specialist assessment or in the investigation of symptoms, depending on the clinical circumstances.

The role of multiparametric MRI before biopsy

A significant feature of the updated guidelines is the routine use of multiparametric MRI, or mpMRI, before prostate biopsy in the specialist setting.

Prostate mpMRI combines different MRI sequences to provide detailed information about the prostate and identify areas that may require further assessment.

According to the updated guidelines, mpMRI can contribute to decisions about whether a biopsy is required and, where biopsy is indicated, help guide targeted sampling of suspicious areas.

PCFA reports that using mpMRI to triage patients before biopsy can reduce the number of unnecessary biopsies and reduce the detection of some low-risk cancers that may not otherwise have caused harm.

MRI does not independently confirm or exclude prostate cancer. Its findings are considered alongside PSA results, individual risk factors, clinical assessment and, where indicated, biopsy results.

What do the updated guidelines mean for GPs?

GPs have an important role at the beginning of the early-detection pathway.

The guidelines support GPs to:

identify men who may be at higher risk
initiate informed conversations about the potential benefits and harms of PSA testing
offer testing according to the relevant age- and risk-based recommendations
repeat an elevated PSA result where appropriate
consider specialist referral when PSA remains at or above the relevant action level.

The Australian Government has announced $320,000 in funding for the Royal Australian College of General Practitioners to develop and implement an education and awareness program to support doctors in understanding the updated guidelines and helping patients make informed decisions about testing.

What do the guidelines mean for specialists?

For urologists and other specialists investigating suspected prostate cancer, the guidelines reinforce the role of mpMRI before biopsy.

MRI findings may help specialists determine whether biopsy is indicated and, if required, identify areas for targeted biopsy.

The updated guidelines also support active surveillance as the preferred management approach for appropriately selected men with low- or very low-risk prostate cancer. Active surveillance may involve regular clinical assessment, PSA testing, MRI and repeat biopsy, based on the patient’s circumstances and specialist advice.

This approach is intended to monitor the cancer while avoiding or delaying treatment, and its potential side effects, when immediate intervention is unlikely to provide a clinical benefit.

Referring for prostate MRI at Lumus Imaging

Lumus Imaging provides prostate MRI services at selected locations across Australia.

Availability, referral requirements and patient preparation may vary between locations.

Use our location finder to find your nearest Lumus Imaging clinic, then contact the clinic directly to confirm whether prostate MRI is available and discuss the relevant referral and appointment information.

Under the Medicare Benefits Schedule, rebates for prostate MRI are available when the scan is requested by an eligible specialist and the patient meets the relevant clinical criteria.

A gap fee may still apply. Patients should contact their chosen Lumus Imaging clinic to confirm referral requirements, eligibility and any potential out-of-pocket costs before their appointment.

References

This article provides a general overview of selected recommendations from the 2026 Guidelines for the Early Detection of Prostate Cancer in Australia. It does not constitute medical advice or replace the complete guidelines, individual clinical judgement or specialist assessment. Healthcare professionals should consult the full guidelines and consider each patient’s individual circumstances.

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