Cochrane Review: PSA Screening Saves 2 Lives Per 1,000 Men
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- Cochrane review of six trials involving nearly 800,000 men found PSA screening reduced prostate cancer deaths by 2 per 1,000 men screened, meaning 500 men must be tested to prevent one death.
- Prof Philipp Dahm of the University of Minnesota, senior author, called the finding a "milestone" for policymakers but stressed the benefit takes "a very extended period of time" to materialize, citing the ERSPC trial's 23-year follow-up.
- Dr Juan Franco of Heinrich Heine University, first author, said the results are "not a blanket endorsement of universal screening" and stressed the "very real risks" of overdiagnosis and the need for shared decision-making.
- The ProtecT trial data cited in the review found 8% to 47% of men reported urinary or sexual function problems after radiotherapy or surgery for prostate cancer.
- Cancer Research UK's Dr Ian Walker noted that while 1-2 lives are saved per 1,000 men screened, around 30 more men could be diagnosed, many of whom would never have been harmed by their disease and could face long-term impacts like loss of bladder control and erectile dysfunction.
- The UK National Screening Committee last year advised against prostate cancer screening for most men but recommended a targeted programme for those with BRCA1 and BRCA2 mutations linked to more aggressive cancers; ministers are reviewing the advice.
Why it matters: Prostate cancer affects one in eight UK men, with over 64,000 cases diagnosed annually, and this Cochrane review gives policymakers the most robust evidence yet that PSA testing prevents roughly 2 deaths per 1,000 men — while also flagging around 30 extra diagnoses per 1,000, many leading to unnecessary treatment. The likeliest path forward is targeted screening for high-risk groups like BRCA mutation carriers rather than a universal programme, leaving individual men to weigh small but real benefits against the harms of overtreatment.
