Study confirms sustained reduction in prostate cancer mortality with PSA screening
The European Randomized Study of Screening for Prostate Cancer (ERSPC) sheds new light on the long-term impact of prostate-specific antigen (PSA) screening on prostate cancer mortality.
The study found that PSA screening results in a 13% relative reduction in prostate cancer mortality 23 years after the start of screening. This means that for every 456 men invited for screening, one death from prostate cancer was prevented compared to those who were not invited.
“Long-term follow-up demonstrates that PSA screening can substantially reduce deaths from prostate cancer,” says Anssi Auvinen, Professor of Epidemiology at Tampere University. “Yet, the effect starts to wane once screening is discontinued and largely disappears within nine years.”
Auvinen is one of the principal investigators of the study and oversees the trial conducted in Finland as part of the multicentre ERSPC.
The study discovered that with PSA screening, one death from prostate cancer was prevented for every 456 men invited for screening and for every 12 men diagnosed with the disease.
However, the absolute benefit of PSA screening increased over time: one death was prevented for every 628 men invited for screening after 16 years of follow-up, but by the end of the study at 23 years, only 456 men needed to be invited to prevent one death.
The main drawback of PSA screening is the detection of clinically insignificant cancers. In some cases, PSA screening leads to overdiagnosis, which may ultimately cause more harm than benefit. Some prostate cancers are so slow-growing that they do not become symptomatic even if left untreated. Treating these indolent, low-risk cancers offers no benefit to patients, but the side effects of treatment may reduce their quality of life.
Risk-based screening is more effective at detecting cancers that require treatment
Within the screening group, the PSA test led to a higher number of diagnosed low-risk cancers but fewer cases of advanced cancers. Elevated PSA levels were found in 16% of the participants in initial tests, but subsequent biopsies confirmed prostate cancer in only 24% of those men. As a result, the researchers noted that a considerable number of the tests and procedures may have been unnecessary.
Nevertheless, the PSA level determined by the screening test is an effective predictor of prostate cancer risk and the likelihood of death from the disease.
Since the start of the ERSPC study in the mid-1990s, substantial progress has been made with risk-based screening approaches. For example, magnetic resonance imaging (MRI) can help to reduce overdiagnosis.
“Risk-based screening would enable the identification of men who are at the highest risk of developing a clinically significant prostate cancer,” Auvinen says.
More than 160,000 men from eight European counties, with nearly half of them from Finland, participated in the study. The Finnish partners included Tampere University, Tampere University Hospital, the University of Helsinki, Helsinki University Hospital as well as the Finnish Cancer Registry. The study was led by the Erasmus University Medical Centre in Rotterdam, the Netherlands.
There is currently no national screening programme for prostate cancer in Finland, but the introduction of PSA screening has become a topic of healthcare policy debate. Prostate cancer is the most common cancer in men. It is the second-leading cause of cancer death in men in Finland and the third-leading in Europe.
Reference: Monique J. Roobol, Ph.D., Ivo I. de Vos, M.D., Marianne Månsson, Ph.D., Rebecka A. Godtman, M.D., Ph.D., Kirsi M. Talala, Ph.D., Elly den Hond, Ph.D., Vera Nelen, M.D., Ph.D., Arnauld Villers, M.D., Ph.D., Gregoire Poinas, M.D., Maciej Kwiatkowski, M.D., Ph.D., Stephen Wyler, Ph.D., M.D., Franz Recker, M.D., Ph.D., Donella Puliti, Ph.D., Giuseppe Gorini, M.D., Ph.D, Marco Zappa, Ph.D., Alvaro Paez, M.D., Marcos Lujan, M.D., Chris H. Bangma, M.D., Ph.D., Teuvo Tammela, M.D., Ph.D., Fritz H. Schröder, M.D., Ph.D., Sebastiaan Remmers, Ph.D., Jonas Hugosson, M.D., Ph.D., and Anssi Auvinen, M.D., Ph.D., Study confirms sustained reduction in prostate cancer mortality with PSA screening, New England Journal of Medicine, Med 2025;393:1669-1680, DOI 10.1056/NEJMoa2503223.
