Do all men have to undergo a prostate cancer test?
What's the story
Screening for prostate cancer using a blood test can save lives, but the overall benefit is limited. A comprehensive study has found that while the prostate-specific antigen (PSA) test does reduce deaths from prostate cancer, many men may undergo unnecessary treatment and face medical complications. The research reviewed six trials with nearly 800,000 men and found that screening with PSA reduced deaths by two for every 1,000 men screened.
Study insights
Benefits of screening more apparent with longer monitoring
The benefits of prostate cancer screening became more apparent with longer patient monitoring periods. This was especially true in the European randomized study of screening for prostate cancer (ERSPC), which followed men for 23 years after screening. "Prostate cancer screening does reduce prostate cancer mortality, although the caveat is that it takes a very extended period of time to realize that benefit," said Professor Philipp Dahm, a urologist at the University of Minnesota and senior author of the Cochrane review.
Screening risks
Unreliable PSA test can lead to unnecessary treatments
The PSA test is known to be unreliable, detecting both life-threatening tumors and benign cancers that may never cause problems. This can lead to unnecessary treatments like radiotherapy, surgery, or hormone therapy. These procedures can result in complications like incontinence and impotence. The review's studies didn't systematically assess the impact of screening on men's quality of life, but the ProtecT trial found between 8% and 47% of men reported urinary or sexual function issues after prostate cancer treatment.
Guidelines review
UK National Screening Committee has an advice
In 2025, the UK National Screening Committee advised against prostate cancer screening for most men. However, it recommended a targeted program for those with BRCA1 and BRCA2 mutations. Prostate cancer is one of the most common cancers in men, with over 64,000 cases diagnosed annually in the UK. The review also looked at newer screening methods that are more precise and aim to avoid unnecessary biopsies by detecting additional prostate-related proteins in blood tests and MRI scans of the gland.
Screening
MRI-led pathways changing the dynamics of screening
David James from Prostate Cancer Research emphasized the evolution of prostate cancer diagnosis and treatment since many trials began. He said, "MRI-led diagnostic pathways, more targeted biopsies, active surveillance and newer biomarker tests are all changing the balance between the benefits and harms of screening." However, Dr Ian Walker from Cancer Research UK stressed that around 30 more men could be diagnosed with the disease through this method, many of whom may never have been harmed by their disease.