Blood tests to detect potential signs of prostate cancer are likely to reduce the risk of death from prostate cancer, a new Cochrane review found. This is a change from an earlier version of the review, which found insufficient evidence that screening reduces deaths from prostate cancer.
Prostate cancer is one of the most common cancers in men. Early detection through screening has long been debated, and experts disagree on whether its benefits outweigh the risks of overdiagnosis and overtreatment.
Small but significant benefits
The study team analyzed data from six trials involving approximately 800,000 participants in Europe and North America. They found that screening with the PSA (prostate-specific antigen) blood test reduced prostate cancer deaths by about 2 deaths for every 1,000 men screened. In other words, to prevent one death from prostate cancer, 500 men would need to be invited for screening. This mortality data comes from a large trial that followed 162,241 men for 23 years.
“With new data available, we can now say with some confidence that PSA screening reduces deaths from prostate cancer in men with ample life expectancy,” said lead author Dr. Philip Dahm of the University of Minnesota.
This suggests that for appropriate patients, those who are well-informed, have a long life expectancy, and fully understand the implications of screening, there is reasonable evidence to support the argument for PSA screening. This represents an important shift in the evidence that future guideline developers and policy makers should consider. ”
AS Dr. Philip Dahm, University of Minnesota
The studies included in this review did not systematically assess the impact on quality of life, such as complications from biopsy, sexual dysfunction, or urinary problems. The authors stress that other studies outside this review, such as the ProtecT trial, also address treatment-related harms and should be considered by decision makers.
However, the risk of overdiagnosis remains an important issue. Screening detects about 30% more prostate cancers overall, most at an early stage. The review found that for every 1 to 2 deaths prevented for every 1,000 men screened, approximately 36 additional cancers were diagnosed. The authors caution that these tests may detect low-grade cancers that may not have caused symptoms or harm during a man’s lifetime, meaning identifying cancer could cause anxiety and unnecessarily aggressive treatment.
“We want to be clear that this is not a total endorsement of universal screening,” said lead author Dr. Juan Franco from Heinrich Heine University of Düsseldorf. “Decisions should always be made between patient and physician and should be made with a full understanding of both the potential benefits and real risks of overdiagnosis and unnecessary treatment.”
Better data, stronger evidence
An earlier version of this review found that prostate cancer screening did not significantly reduce deaths from prostate cancer, based on a meta-analysis of five randomized controlled trials. This uncertainty was a major factor in the decision not to introduce national testing programs in some countries.
The authors say the small benefit observed in this review is not due to changes in the underlying evidence, but is primarily because trials now follow participants long enough to detect a mortality benefit that was previously too early to see.
“Things have changed significantly since the 2013 review,” says Dr. Franco. “Not only is there strong long-term evidence on mortality, but there have also been significant advances in the tools available to reduce the harms of screening, such as MRI and active surveillance.”
The review also looked at a new generation of screening approaches that combine the PSA test with kallikrein panel blood tests and MRI scans, which are more accurate and designed to reduce unnecessary biopsies. MRI and active surveillance are approaches to detect less aggressive cancers that do not require aggressive treatment, reducing the harms of overtreatment. Early trial data suggests these methods may detect more cancers, but it is too early to know whether they will save more lives or cause less harm than PSA testing alone.
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Reference magazines:
Franco, co-venturer; others. (2026) Prostate-specific antigen (PSA) test for prostate cancer screening. Cochrane Database of Systematic Reviews. DOI: 10.1002/14651858.cd004720.pub4. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004720.pub4/full.
