A study indicates that while prostate cancer testing can be life-saving, its overall positive impact is minor.

A comprehensive new study indicates that while prostate cancer screening through a blood test can save lives, its absolute benefit remains small, potentially leading many men to undergo unnecessary treatment and suffer medical complications.

The review, which analyzed six trials involving nearly 800,000 men, found that the prostate-specific antigen (PSA) test reduced prostate cancer deaths by two for every 1,000 men screened. This means approximately 500 men must be screened to prevent a single death from the disease. The life-saving benefit emerged only after extended monitoring periods, notably over 23 years in the European Randomized Study of Screening for Prostate Cancer (ERSPC).

“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,” stated Professor Philipp Dahm, a urologist at the University of Minnesota and senior author of the Cochrane review. He added that this finding represents a milestone likely to influence policymakers.

Many countries, including the UK, lack formal prostate cancer screening programs primarily due to the PSA test’s unreliability. Beyond identifying life-threatening tumors, the test frequently detects benign cancers that might never cause health issues. Such diagnoses can lead to men receiving radiotherapy, surgery, or hormone therapy, thereby exposing them to risks like incontinence and impotence. While the review studies did not systematically evaluate screening’s impact on quality of life, the ProtecT trial reported that between 8% and 47% of men experienced urinary or sexual dysfunction following radiotherapy or surgery for prostate cancer.

Dr. Juan Franco, the review’s first author from Heinrich Heine University in Düsseldorf, emphasized that the results do not constitute a “blanket endorsement of universal screening.” He highlighted the “very real risks” of overdiagnosis and unnecessary treatment, stressing the importance of thorough patient discussions and shared decision-making.

Prostate cancer is a prevalent malignancy among men, with over 64,000 cases diagnosed annually in the UK. One in eight men develops the disease in their lifetime, a figure that rises to a quarter among Black men.

Last year, the UK National Screening Committee advised against widespread prostate cancer screening for most men. However, it recommended a targeted program for individuals with BRCA1 and BRCA2 mutations, which are linked to more aggressive cancers. Ministers are currently reviewing this advice.

Professor Dahm noted that screening is more advisable for men expected to live at least another 10 to 15 years. He explained that for individuals with significant co-morbidities limiting life expectancy, prostate cancer, often slow-growing, is generally less of a concern.

The review also considered recent advancements in screening methods, such as testing for additional prostate-related proteins and using MRI scans to improve precision and reduce unnecessary biopsies. Although these approaches appear promising, researchers caution it is too early to determine their effectiveness in saving more lives or causing less harm.

David James from Prostate Cancer Research commented that the review confirms screening reduces deaths from the disease. He also underscored the evolution of prostate cancer diagnosis and treatment since many of these trials began, citing “MRI-led diagnostic pathways, more targeted biopsies, active surveillance and newer biomarker tests” as factors altering the balance of screening benefits and harms.

Conversely, Dr. Ian Walker of Cancer Research UK pointed out that the review clarifies why a widespread UK screening program remains absent. He acknowledged the potential for the PSA test to save one to two lives per 1,000 men screened but countered that it could also lead to approximately 30 additional diagnoses. Many of these would be for cancers that would never have caused harm, resulting in unnecessary treatments with long-term consequences such as loss of bladder control and erectile dysfunction.

Dr. Matthew Hobbs of Prostate Cancer UK concluded that while PSA screening can save lives, it is “not nearly enough.” He urged for more research to address critical evidence gaps and identify safer, more effective screening methods where benefits clearly outweigh harms. In the interim, he stressed the necessity of enabling all men at risk to make informed choices about PSA blood testing, emphasizing transparency about both the benefits and potential harms of such a complex decision.


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