A European study finds PSA screening can reduce prostate cancer deaths over the long term, though it also raises concerns about overdiagnosis. Researchers urge risk-based screening to balance benefits and harms.
The European Randomized Study of Screening for Prostate Cancer (ERSPC) shows the long-term impact of prostate-specific antigen (PSA) testing on prostate cancer mortality. Published in the New England Journal of Medicine, the study reports a 13% relative reduction in prostate cancer deaths 23 years after screening began.
Long-term follow-up supervisor Anssi Auvinen, a professor of epidemiology at Tampere University, notes that the mortality benefit is clear but not permanent. “PSA screening can substantially reduce deaths from prostate cancer,” he says, but the effect fades after screening stops and largely disappears within nine years.
Auvinen leads the Finnish portion of the multicenter ERSPC trial. The study found that PSA screening prevented one death from prostate cancer for every 456 men invited to screening and for every 12 men diagnosed with the disease. Over time, the absolute benefit grew: after 16 years, one death was prevented for every 628 men invited; by 23 years, the figure was 456.
A major drawback is the detection of clinically insignificant cancers. Overdiagnosis can lead to overtreatment, with little or no patient benefit and potential harm to quality of life from treatment side effects. Some cancers are so slow growing that they would not cause symptoms or death if left untreated.
Risk-based screening may improve the balance. In the screened group, more low-risk cancers were detected, while fewer advanced cancers appeared. Although 16% of participants had elevated PSA on initial tests, only 24% of those with elevated PSA were confirmed to have prostate cancer after biopsy, suggesting many tests and procedures may have been unnecessary.
Nevertheless, PSA levels remain a strong predictor of cancer risk and mortality. Since the ERSPC began in the mid-1990s, approaches like magnetic resonance imaging (MRI) have helped reduce overdiagnosis.
Proponents argue risk-based screening could target men at highest risk of clinically significant disease, potentially increasing benefits while reducing harms.
Participants in the ERSPC study totaled more than 160,000 men across eight European countries, with nearly half from Finland. Finnish institutions involved include Tampere University, Tampere University Hospital, the University of Helsinki, Helsinki University Hospital, and the Finnish Cancer Registry. The Erasmus University Medical Center led the study in Rotterdam, the Netherlands.
Finland currently has no national prostate cancer screening program, but PSA screening remains a topic of health policy debate. Prostate cancer is the most common cancer among men in Finland and ranks high in Europe for cancer deaths.
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