A comprehensive new review of nearly 800,000 men has found that screening for prostate cancer using a blood test is likely to reduce deaths from the disease. However, experts have issued a warning about the potential for overdiagnosis and overtreatment.
PSA Test Shows Promise in Reducing Mortality
The analysis, a Cochrane review, examined data from six trials involving 789,086 patients, with five trials contributing to the final results. Participants ranged in age from 45 to 80, but most were between 50 and 70. The findings indicate that without screening, 16 men per 1,000 would die from prostate cancer. Screening reduced this number by two deaths, to 14 per 1,000 men.
Lead author Dr. Juan Franco of Heinrich Heine University Dusseldorf described the PSA test as "an imperfect test" and noted that there are "many kinds" of prostate cancer. He explained that some cancers are aggressive and potentially fatal, while others are benign and may never cause problems. The test can detect these harmless tumors, leading to overdiagnosis and unnecessary treatment.
Concerns About Overdiagnosis and Side Effects
The trials did not examine impacts on quality of life, such as complications from biopsies, sexual dysfunction, or urinary problems. However, Dr. Franco pointed to other studies suggesting overdiagnosis rates between 20% and 50% for prostate cancer. He warned that men diagnosed with benign cancers may undergo treatments like radiation, surgery, or hormone therapy, which carry side effects including incontinence and erectile dysfunction.
Senior author Dr. Philipp Dahm of the University of Minnesota said the findings "support a conversation about PSA screening." He emphasized that for well-informed men with a good life expectancy, there is now a reasonable evidence base to discuss screening. This marks a shift from a previous Cochrane review in 2013, which concluded that screening did not meaningfully reduce deaths.
No UK Screening Programme Yet
Currently, there is no prostate cancer screening programme in the UK, although men over 50 can request a PSA test from their GP. In November, the UK National Screening Committee (UKNSC) decided not to back PSA screening, stating it was likely to cause more harm than good. The committee only recommended screening every two years for men aged 45 to 61 with BRCA1 or BRCA2 genetic mutations, who are at higher risk.
Dr. Ian Walker of Cancer Research UK commented that the test "is not effective enough" and highlighted the complex balance between benefits and harms. He noted that while screening could save one to two lives per 1,000 men, it could also lead to around 30 additional diagnoses, many of which would never have caused harm.
The findings come as the Transform trial, funded by Prostate Cancer UK and the National Institute for Health and Care Research, begins testing men using genetic tests and 10-minute MRI scans to find safer and more cost-effective screening methods.
