A comprehensive review of prostate cancer screening has confirmed that while a blood test can save lives, the absolute benefit is small and many men may face unnecessary treatment. The study, published by Cochrane, analyzed 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 500 men must be screened to prevent one death from the disease.
Long-Term Benefits and Risks
The benefit became apparent as patients were monitored for longer periods, particularly in the European Randomized Study of Screening for Prostate Cancer (ERSPC), which followed men for 23 years after screening. Professor Philipp Dahm, a urologist at the University of Minnesota and senior author of the review, said: "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. This finding is a milestone and I think it will make a difference for a lot of policymakers."
However, the PSA test is known to be unreliable. It can detect life-threatening tumours but also picks up many benign cancers that may never cause problems. This can lead to men undergoing radiotherapy, surgery, or hormone therapy, putting them at risk of complications such as incontinence and impotence. The ProtecT trial found that between 8% and 47% of men reported problems with urinary or sexual function after such treatments.
Call for Shared Decision Making
Dr Juan Franco at Heinrich Heine University in Düsseldorf, the first author of the review, emphasized that the results are "not a blanket endorsement of universal screening" and stressed the "very real risks" of overdiagnosis and unnecessary treatment. He said: "It's important to have, ultimately, discussion with patients, and what we call shared decision making."
Prostate cancer is one of the most common cancers in men. In the UK, more than 64,000 cases are diagnosed annually, with one in eight men developing the disease in their lifetime, rising to a quarter of Black men. Currently, the UK and many other countries have no formal prostate cancer screening programmes due to the test's unreliability. Last year, the UK National Screening Committee advised against widespread screening but recommended a targeted programme for men with BRCA1 and BRCA2 mutations.
Future Directions
The review also examined recent advances in screening, such as testing for more prostate-related proteins and using MRI scans to reduce unnecessary biopsies. While these appear promising, the researchers said it was too early to know if they could save more lives or cause less harm. David James at Prostate Cancer Research noted that MRI-led diagnostic pathways and active surveillance are changing the balance between benefits and harms. Dr Ian Walker at Cancer Research UK highlighted that while the test could save one to two lives per 1,000 men screened, around 30 more men could be diagnosed unnecessarily. Dr Matthew Hobbs at Prostate Cancer UK concluded that more research is needed to find the safest and most effective screening method.
