Study Shows PSA Screening Reduces Prostate Cancer Deaths

A comprehensive analysis of the European Randomized Study of Screening for Prostate Cancer (ERSPC) indicates that sustained, protocolized screening using prostate-specific antigen (PSA) tests significantly reduces prostate cancer mortality. The findings, published in The New England Journal of Medicine on March 15, 2025, underline the potential of risk-based, patient-centered screening strategies to enhance clinical outcomes while managing associated risks.

The ERSPC trial’s 23-year follow-up data reveal that men aged 55 to 69 who underwent regular PSA testing experienced a 13% relative reduction in prostate cancer deaths compared to those who did not participate in screening. Specifically, mortality rates were 1.4% in the screening group compared to 1.6% in the control group, translating to an absolute risk reduction of 0.22%. This indicates that inviting 456 men to screening prevents one death from prostate cancer, while diagnosing 12 men results in one fewer death.

The importance of balancing the benefits of early detection with potential harms was highlighted throughout the study. While PSA testing can lead to early identification of cancers, it may also result in false positives, unnecessary biopsies, and treatments that do not improve survival. The study emphasizes the need for health systems to weigh the reduction in mortality against potential declines in quality of life and resource allocation.

Study Design and Key Findings

Conducted across eight European countries, the ERSPC trial randomized participants into two groups: one receiving repeated PSA tests and another that did not receive screening invitations. The screening utilized standardized Hybritech assays, with various intervals for inviting men based on country-specific protocols. For instance, men in Sweden and France were invited every two years, while those in Belgium were invited every seven years.

The primary outcome measured was prostate cancer mortality, assessed by blinded local committees. Secondary outcomes included the rates of prostate cancer incidence and the occurrence of advanced disease, with a focus on lymph-node or bone metastases.

Data analysis employed Poisson regression and competing-risk methods, taking into account mortality from other causes. The study found that compliance with screening was high, with approximately 83% of invited men attending at least one screening round, and 89% of those with positive PSA tests proceeding to biopsy. Nevertheless, only about 24% of biopsies confirmed the presence of cancer, illustrating the challenge of overdiagnosis.

Implications for Future Screening Policies

The findings underscore the imperative for health systems to adopt risk-based screening intervals tailored to individual patient profiles. The study suggests that shared decision-making should incorporate factors such as baseline PSA levels, life expectancy, and personal values to enhance patient-centered care.

The ERSPC trial’s results are especially relevant when compared to other prominent studies, such as the PLCO trial in the United States and the CAP trial in the United Kingdom. Both trials faced challenges that potentially obscured their findings, emphasizing the importance of rigorous design and implementation in screening protocols.

As prostate cancer incidence rises globally, the evidence from the ERSPC trial advocates for a shift towards more individualized screening strategies. By focusing on the balance between the benefits and harms of screening, health systems can optimize outcomes for patients while reducing the risks associated with overdiagnosis.

In conclusion, the 23-year follow-up of the ERSPC highlights the efficacy of structured PSA screening in reducing prostate cancer mortality, reinforcing the need for evidence-based, patient-centered approaches in the evolving landscape of cancer detection and management.