PSA Prostate Cancer Screening Cuts Deaths but Benefit Small, Review Finds

Prostate cancer screening with a blood test can save men's lives, but the absolute benefit remains small and many men risk unnecessary treatment and complications, according to the most comprehensive study to date.

The review analyzed six trials involving nearly 800,000 men. Screening with the prostate-specific antigen (PSA) test cut prostate cancer deaths by two for every 1,000 men screened. That means 500 men must be screened to prevent one death from the disease.

The benefit showed up after longer monitoring periods, especially in the European Randomized Study of Screening for Prostate Cancer (ERSPC), which tracked men for 23 years post-screening.

"Prostate cancer screening does reduce prostate cancer mortality, although the caveat is that it takes a very extended period of time to realize that benefit," said Prof. Philipp Dahm, a urologist at the University of Minnesota and senior author of the Cochrane review. "This finding is a milestone and I think it will make a difference for a lot of policymakers."

The UK and many other countries lack formal prostate cancer screening programs, mainly because the PSA test proves unreliable. It flags life-threatening tumors along with many benign ones that may never cause issues. Men then often undergo radiotherapy, surgery or hormone therapy, facing risks like incontinence and impotence.

The reviewed studies did not systematically check screening's effect on men's quality of life. But the ProtecT trial found 8% to 47% of men reported urinary or sexual function problems after radiotherapy or surgery for prostate cancer.

Dr. Juan Franco at Heinrich Heine University in Düsseldorf, the review's first author, said the results offer "not a blanket endorsement of universal screening" and pointed to the "very real risks" of overdiagnosis and unnecessary treatment. "It's important to have, ultimately, discussion with patients, and what we call shared decision making," he said.

Prostate cancer ranks among the most common cancers in men. The UK diagnoses more than 64,000 cases yearly, with one in eight men developing it in their lifetime and one in four Black men affected.

Last year, the UK National Screening Committee advised against routine prostate cancer screening for most men but recommended a targeted program for those with BRCA1 and BRCA2 mutations linked to aggressive cancers. Ministers are reviewing that advice.

Dahm said screening suits men expected to live another 10 to 15 years. "If you have a lot of competing medical comorbidities that are much more likely to limit your life expectancy, you just don't have to worry about prostate cancer for the most part, because most prostate cancer is slow growing," he said.

The review also looked at newer screening advances aimed at greater precision. These include blood tests for additional prostate-related proteins and MRI scans of the gland to cut unnecessary biopsies. The researchers said such methods appear promising but remain too early to judge on saving more lives or reducing harm.

David James at Prostate Cancer Research said the review confirms screening reduces deaths from the disease. "It's also important to recognize how much prostate cancer diagnosis and treatment have evolved since many of these trials began," he said. "MRI-led diagnostic pathways, more targeted biopsies, active surveillance and newer biomarker tests are all changing the balance between the benefits and harms of screening."

Dr. Ian Walker at Cancer Research UK said the review explains the absence of a widespread UK screening program. "Whilst this review does highlight that the test could save one to two lives from prostate cancer for every 1,000 men screened, it also shows that around 30 more men could be diagnosed with the disease, many of whom would never have been harmed by their disease and could go on to have unnecessary treatment with long-term impacts like the loss of bladder control and erectile dysfunction."

Dr. Matthew Hobbs at Prostate Cancer UK said the study shows PSA screening can save lives "but not nearly enough".

He added: "More research is needed to plug critical evidence gaps and to find the safest and most effective way to screen men for prostate cancer, ensuring the benefits outweigh the harms. In the meantime, we must ensure that all men at risk of prostate cancer can make informed choice about whether or not to have a PSA blood test, so each man can decide what is best for him. This research shows again that this is not a simple decision, and we must be honest with men about the benefits but also about the potential harms."