A major review of prostate cancer screening has confirmed that blood tests can reduce deaths from the disease, but the absolute benefit is modest and many men may face unnecessary treatment. The analysis, published by the Cochrane Collaboration, examined six trials involving nearly 800,000 men and found that screening with the prostate-specific antigen (PSA) test prevented one death from prostate cancer for every 500 men screened.
The review, which included long-term follow-up data from the European Randomised Study of Screening for Prostate Cancer (ERSPC) spanning 23 years, reported that screening reduced prostate cancer deaths by two per 1,000 men. However, the authors stress that this small benefit must be weighed against the risks of overdiagnosis and overtreatment. The PSA test is known to detect many slow-growing cancers that would never cause harm, leading to potentially unnecessary radiotherapy, surgery, or hormone therapy, which can result in complications such as incontinence and erectile dysfunction.
Evidence from the ProtecT trial indicated that between 8% and 47% of men who underwent treatment reported problems with urinary or sexual function. Dr Juan Franco, the lead author from Heinrich Heine University in Düsseldorf, said the findings are not a blanket endorsement for universal screening. “It’s important to have shared decision making with patients,” he emphasised.
In the UK, where more than 64,000 prostate cancer cases are diagnosed annually, there is currently no national screening programme. The UK National Screening Committee last year advised against routine screening for most men but recommended targeted screening for those with BRCA mutations linked to aggressive cancers. The government is reviewing this advice.
Professor Philipp Dahm, senior author of the review, noted that screening becomes more beneficial for men with a life expectancy of at least 10 to 15 years, as most prostate cancers are slow-growing. The review also highlighted newer diagnostic methods, such as MRI-led pathways and biomarker tests, which may improve the balance of benefits and harms, but researchers caution that it is too early to draw firm conclusions.
