A landmark European study has found that regular prostate-specific antigen (PSA) screening can significantly reduce deaths from prostate cancer, with the benefits growing stronger over time.

The results, published in the New England Journal of Medicine, show that men who were offered PSA screening were 13% less likely to die from prostate cancer than those who weren’t screened.

The results demonstrate that for every 456 men invited for screening, one death from prostate cancer was prevented, compared with 628 men in earlier results. Similarly, only 12 men needed to be diagnosed to prevent one death, compared with 18 in previous analyses, showing that the balance between benefit and harm has improved.

“These long-term results show that PSA screening saves lives,” said Professor Monique J. Roobol, lead researcher at Erasmus MC Cancer Institute in Rotterdam.

“We now have a clearer picture of the benefits, which become more evident as time goes on, while the potential harms of overdiagnosis are gradually reducing.”

The European Randomized Study of Screening for Prostate Cancer (ERSPC) began in 1993 and remains the largest trial of its kind. It involved 162,236 men aged 55 to 69 from eight European countries, who were either invited for regular PSA testing or received standard care without screening.

Over more than two decades, the study showed:

• 13% lower prostate cancer mortality among screened men (rate ratio 0.87, 95% CI 0.80–0.95)
• Absolute risk reduction of 0.22%
• 22 prostate cancer deaths prevented per 10,000 men screened, compared with 14 per 10,000 in earlier analyses
• A modest increase in prostate cancer diagnoses (27 extra cases per 1,000 men), reflecting ongoing challenges with overdiagnosis

The study has drawn praise from leading cancer researchers, who say the findings could help shape future screening policy and improve early detection.

Dr Matthew Hobbs, Director of Research at Prostate Cancer UK, said:

“The ERSPC trial was one of the largest ever conducted, and even 23 years later it’s still teaching us new things.

We can now see that PSA screening prevents more deaths than previously thought, while the harms have fallen. This kind of high-quality evidence is exactly what the National Screening Committee needs to look at — especially for men at higher risk, like Black men and those with a family history.”

He added that the charity has committed £42 million to the TRANSFORM trial, which will test modern screening methods using MRI and AI to reduce unnecessary biopsies and treatments.

“We’ve come a long way, but we can’t stop here. With 12,000 men still dying each year in the UK, we need smarter screening to catch cancers early and save more lives.”

Experts say that the harms seen in the original trial, such as overdiagnosis and overtreatment, are likely less severe today thanks to advances in imaging and diagnostics.

Professor Sam Hare, CEO of the HLH Imaging Group and former National Specialty Adviser for Imaging at NHS England, said:

“This study adds real weight to the case for screening. But it also reminds us that PSA alone isn’t enough. With today’s use of high-quality MRI scans, artificial intelligence, and safer biopsy methods, we can make prostate cancer screening both more accurate and more effective.”

Mr Veeru Kasivisvanathan, Associate Professor of Urology at University College London, described the ERSPC as “a landmark study in Urology,” saying:

“The results now show a benefit on par with colon and breast cancer screening. But we need to be smarter, not every man benefits equally. The future lies in risk-based screening that combines PSA testing with MRI, genetics, and better tools to identify who’s most at risk.”

While the ERSPC confirms that PSA testing saves lives, the authors stress the need for a more personalised approach that focuses on men most likely to benefit while avoiding unnecessary interventions.

“We’re moving toward smarter screening,” said Professor Roobol. “PSA testing remains an important part of early detection, but the future is about precision screening, combining PSA with modern imaging and genetic tools to find cancers that matter and avoid treating those that don’t.”

Reference:

Roobol MJ, et al. European Study of Prostate Cancer Screening — 23-Year Follow-up. New England Journal of Medicine. 2025.

(Funded by the Dutch Cancer Society and others; ISRCTN49127736)

Science Media Centre. (2025, October 29). Expert reaction to 23‑year follow‑up data from the European Randomized Study of Screening for Prostate Cancer. Retrieved from https://www.sciencemediacentre.org/expert-reaction-to-23-year-follow-up-data-from-the-european-randomized-study-of-screening-for-prostate-cancer/