A major new review has confirmed that screening for prostate cancer using a blood test can save lives, but the absolute benefit remains modest and many men may face unnecessary treatment and complications. The comprehensive analysis, published by Cochrane, examined six trials involving nearly 800,000 men and found that screening with the prostate-specific antigen (PSA) test reduced prostate cancer deaths by two for every 1,000 men screened. This means that 500 men need to be screened to prevent one death from the disease.
Long-term benefits and caveats
The benefit became more apparent over longer follow-up periods, particularly in the European Randomized Study of Screening for Prostate Cancer (ERSPC), which tracked men for 23 years. Professor Philipp Dahm, a urologist at the University of Minnesota and senior author of the review, noted: “Prostate cancer screening does reduce prostate cancer mortality, although the caveat is that it takes a very extended period of time to realise that benefit. This finding is a milestone and I think it will make a difference for a lot of policymakers.”
However, the UK and many other countries do not have formal prostate cancer screening programmes, largely because the PSA test is unreliable. It can detect life-threatening tumours but also picks up many benign cancers that may never cause harm. This leads to overdiagnosis and unnecessary treatments such as radiotherapy, surgery, or hormone therapy, which carry risks of incontinence and impotence.
Quality of life and shared decision-making
The studies in the review did not systematically assess the impact on quality of life, but the ProtecT trial found that between 8% and 47% of men reported problems with urinary or sexual function after treatment. Dr Juan Franco from Heinrich Heine University in Düsseldorf, the first author, stressed that the results are “not a blanket endorsement of universal screening” and highlighted the “very real risks” of overdiagnosis. He emphasised the importance of shared decision-making with patients.
Prostate cancer is one of the most common cancers in men, with over 64,000 cases diagnosed annually in the UK. One in eight men will develop it in their lifetime, rising to one in four Black men. Last year, the UK National Screening Committee advised against universal screening but recommended a targeted programme for men with BRCA1 and BRCA2 mutations, which are linked to more aggressive cancers. Ministers are currently reviewing this advice.
Who should consider screening?
Professor Dahm said screening is more sensible for men with a life expectancy of at least 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 explained.
The review also looked at newer screening approaches, such as testing for multiple prostate-related proteins in the blood and using MRI scans. While these appear promising, the researchers said it is too early to know if they can save more lives or cause less harm.
Expert reactions
David James from Prostate Cancer Research said the review shows that screening reduces deaths, but added: “It’s also important to recognise how much prostate cancer diagnosis and treatment have evolved since many of these trials began. MRI-led diagnostic pathways, more targeted biopsies, active surveillance and newer biomarker tests are all changing the balance between benefits and harms.”
Dr Ian Walker from Cancer Research UK highlighted why there is no widespread UK screening programme: “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 and could go on to have unnecessary treatment with long-term impacts like loss of bladder control and erectile dysfunction.”
Dr Matthew Hobbs from Prostate Cancer UK said the study shows that PSA screening can save lives “but not nearly enough”. He called for more research to find the safest and most effective screening method, ensuring benefits outweigh harms. “In the meantime, we must ensure that all men at risk can make an informed choice about whether to have a PSA 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 about the benefits and potential harms.”
