At what age should men actually start getting screened for prostate cancer?

With Joe Biden's cancer story back in the news, what are the real medical guidelines on when men should get screened, and why do some older men not get routinely tested?

General guidelines (in the US, from groups like the American Cancer Society) suggest most men should discuss prostate cancer screening with a doctor starting around age 50, or earlier — around 40-45 — for those at higher risk, including Black men and men with a father or brother diagnosed with prostate cancer before age 65. Screening typically involves a PSA (prostate-specific antigen) blood test and sometimes a physical exam, and it's usually framed as a shared decision between patient and doctor rather than a fixed rule, since the disease can behave very differently from person to person. Notably, and directly relevant to why this specific case drew attention: the American Urological Association generally doesn't recommend routine PSA screening for men over 70, based on the reasoning that prostate cancer is often slow-growing at that age and aggressive treatment can carry more risk than benefit for many older patients — this guidance is part of why some later-stage diagnoses in older men happen without an obvious earlier screening opportunity being missed. Persistent urinary symptoms — frequent urination (especially at night), difficulty starting or stopping, or blood in urine — are still worth raising with a doctor at any age, regardless of routine screening schedules, since symptoms can prompt targeted testing even outside standard screening guidelines.