Prostate cancer screening

There is a lack of data from randomised control trials which show the benefit to harm ratio of using the PSA test for prostate cancer screening. But evidence from Europe has shown that the PSA test can be used to save lives but it is unknown how many cases would be diagnosed and subsequently overtreated (1).

• interim results from a large European randomised controlled trial (2) and a large US study show that screening with prostate-specific antigen (PSA) testing (combined with digital rectal examination [DRE] in the US study) (3) detects many more cancers than usual care
  • in the US, before the use of PSA test (pre-PSA era) the lifetime risk of prostate cancer diagnosis was around 8% while it has risen to 19% in the current PSA era (1)
• however, a review notes caution and states
  • "..the value of prostate cancer screening is still unclear.... whether or not this (results of the studies mentioned) translates into a survival benefit from prostate cancer remains uncertain.."(4)
    • interim results from the European study (n=162,243) suggest that, over nine years, 1,410 men would need to be screened with PSA testing (and 48 additional men with cancer would need to be treated) to prevent one death from prostate cancer
• a US cross-sectional study (5) noted:
  • Question Was the 2012 US Preventive Services Task Force (USPSTF) Grade D recommendation against prostate-specific antigen (PSA) screening for all men associated with prostate cancer–specific mortality (PCSM)?
  • Findings This cross-sectional study found statistically significant changes in PCSM rates that coincided with the change in the screening guideline; PCSM rates were decreasing prior to the recommendation and remained steady after the recommendation.
  • Meaning This study suggests that the change in the USPSTF PSA screening guideline to a Grade D recommendation against PSA screening for all men may have been associated with the stagnancy of PCSM rates
• a study investigated whether a single invitation for a prostate-specific antigen (PSA) screening test reduce prostate cancer mortality at 15-year follow-up compared with no invitation for testing (6):
  • secondary analysis of a randomized clinical trial of 415 357 men aged 50 to 69 years randomized to a single invitation for PSA screening (n = 195 912) or a control group without PSA screening (n = 219 445) and followed up for a median of 15 years, risk of death from prostate cancer was lower in the group invited to screening (0.69% vs 0.78%; mean difference, 0.09%) compared with the control group
  • study authors stated that "..showed that compared with no invitation for routine PSA testing, a single invitation for a PSA screening test reduced prostate cancer mortality at a median follow-up of 15 years, but the absolute mortality benefit was small.."

The UK National Screening Committee state (7):

“..Based on the 2025 to 2026 review of evidence into prostate cancer screening, the modelling study and consultation with stakeholders, the UK NSC:

• does not recommend population screening for this condition
• recommends a targeted screening programme, involving PSA testing every 2 years, for men aged 45 to 61 who have a pathogenic (able to cause disease) BRCA2 variant with a family history of breast, ovarian, pancreatic, or prostate cancer
• recommends that the best method of identifying and inviting the above high-risk group should be evaluated over time
• does not recommend targeted screening for any other risk groups
• will continue to work closely with UK researchers, including the TRANSFORM trial, to address uncertainties in the evidence regarding targeted screening of black men and other risk groups

The committee concluded that screening is more likely to cause more harm than good in the whole population and in men with a family member who has had breast, ovarian or prostate cancer but who do not have a BRCA2 variant. For black men, there is ongoing uncertainty as to whether screening would cause more good than harm. The main harms of prostate cancer screening include incontinence and erectile dysfunction in men who do not need treatment…”

Reference:

1. Prostate Cancer Risk Management Programme Information for primary care; PSA testing in asymptomatic men. Evidence document. NHS Cancer Screening Programmes, 2010
2. MeReC Extra No 40 July 2009
3. Schröder FH, Hugosson J, Roobol MJ, et al, for the ERSPC investigators. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009;360:132-8
4. Andriole GL, Crawford ED, Grubb RL, et al, for the PLCO Project Team. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 2009;360:1310-9
5. Burgess L, Aldrighetti CM, Ghosh A, et al. Association of the USPSTF Grade D Recommendation Against Prostate-Specific Antigen Screening With Prostate Cancer-Specific Mortality. JAMA Netw Open. 2022;5(5):e2211869. doi:10.1001/jamanetworkopen.2022.11869
6. Martin RM, Turner EL, Young GJ, et al. Prostate-Specific Antigen Screening and 15-Year Prostate Cancer Mortality: A Secondary Analysis of the CAP Randomized Clinical Trial. JAMA. Published online April 06, 2024. doi:10.1001/jama.2024.4011.
7. "Prostate Cancer Screening Recommendation." GOV.UK, UK National Screening Committee, Accessed 3 June 2026