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An updated Cochrane review reports that prostate-specific antigen (PSA) screening may reduce the risk of dying from prostate cancer. Earlier versions of the review did not find sufficient evidence of a mortality benefit; therefore, the updated findings may be relevant to guideline developers and payers considering whether and how to support population screening.
The review team analyzed six trials involving nearly 800,000 participants across Europe and North America. They estimated that PSA screening is associated with about two fewer prostate cancer deaths for every 1,000 men screened. Another way to express the finding is that about 500 men would need to be invited to screening to prevent one prostate cancer death. The mortality estimate draws in part on a large trial that followed 162,241 men for 23 years.
The review also considers potential harms alongside potential benefits. Screening identified about 30% more prostate cancers overall, many at an earlier stage, with roughly 36 additional cancers diagnosed per 1,000 men screened for every one to two prostate cancer deaths prevented. Some detected cancers may be low grade and may never cause symptoms, which can lead to anxiety, additional testing, and treatment that carries its own risks. The review did not systematically assess quality-of-life outcomes such as biopsy complications, sexual dysfunction, and urinary problems, and the authors refer to other evidence, including the ProtecT trial, on treatment-related harms.
The authors describe the updated conclusion as reflecting longer follow-up rather than necessarily indicating a new effect, since the trials have now followed participants long enough to detect a mortality difference that may not have been observable earlier. They also reviewed newer strategies that combine PSA testing with a kallikrein panel and MRI, as well as active surveillance, which are intended to reduce unnecessary biopsies and overtreatment. Evidence is still developing on whether these approaches improve mortality outcomes.
The authors note that the findings do not amount to an endorsement of universal screening. They emphasize that screening decisions should be made through discussion between patients and clinicians, with attention to both the potential benefits and the risks of overdiagnosis and overtreatment.
