Here’s a startling fact: prostate cancer is the most common cancer in men and a leading cause of cancer death worldwide. But what if a simple screening test could significantly reduce those numbers? A groundbreaking European study has revealed that prostate-specific antigen (PSA) screening can lead to a sustained, long-term reduction in prostate cancer mortality. But here’s where it gets controversial: while PSA screening saves lives, it also raises concerns about overdiagnosis—detecting slow-growing cancers that may never harm the patient. So, is the benefit worth the risk? Let’s dive in.
The European Randomized Study of Screening for Prostate Cancer (ERSPC) has shed new light on the impact of PSA screening over 23 years. Published in the New England Journal of Medicine, the study found that PSA screening results in a 13% relative reduction in prostate cancer mortality. Professor Anssi Auvinen, a lead researcher, explains, 'Long-term follow-up shows PSA screening can substantially reduce deaths from prostate cancer. However, the effect diminishes once screening stops and nearly disappears within nine years.'
And this is the part most people miss: the study also highlights that for every 456 men invited for screening, one prostate cancer death is prevented. Over time, this benefit becomes more pronounced—by the 23-year mark, only 456 men need to be screened to save one life. But there’s a catch. PSA screening often detects low-risk, slow-growing cancers that may not require treatment. Treating these cancers can expose patients to unnecessary side effects, potentially reducing their quality of life.
To address this, researchers advocate for risk-based screening—a more targeted approach that identifies men at the highest risk of developing aggressive prostate cancer. For instance, combining PSA testing with magnetic resonance imaging (MRI) can help reduce overdiagnosis. 'Risk-based screening would allow us to focus on men who truly need intervention,' says Auvinen.
The ERSPC study involved over 160,000 men from eight European countries, with nearly half from Finland. Despite these findings, Finland currently has no national prostate cancer screening program, sparking debates in healthcare policy. Prostate cancer remains the second-leading cause of cancer death in Finnish men and the third in Europe.
Here’s a thought-provoking question: Should countries implement widespread PSA screening despite the risk of overdiagnosis, or should they prioritize risk-based approaches? Let us know your thoughts in the comments.
For more details, check out the study by Monique J. Roobol et al., European Study of Prostate Cancer Screening—23-Year Follow-up, published in the New England Journal of Medicine (2025). DOI: 10.1056/nejmoa2503223. This research not only advances our understanding of prostate cancer screening but also challenges us to balance lifesaving benefits with potential harms.
