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New data from a major European trial tracking more than 160,000 men for over two decades has found that men who were screened for early signs of prostate cancer were 13% less likely to die from the disease. The research showed that for every 456 men who were offered prostate specific antigen (PSA) testing, one life was saved. However, the tests also picked up cancers that might never have caused problems, leading to unnecessary treatments and side effects. The authors say that future prostate screening should use risk-based strategies to maximise benefits without causing harm.
The All Ireland Science Media Centre asked local experts to comment. Our colleagues at the UK Science Media Centre also gathered comments.
Dr Amirhossein Jalali, Associate Professor of Biostatistics, University of Limerick, comments:
“This 23-year follow-up of the European Study of Prostate Cancer Screening provides robust evidence that PSA screening is associated with a long-term reduction in prostate cancer mortality. It demonstrates a continued mortality benefit, with a 13% relative reduction in prostate cancer deaths, and a more favourable balance between benefits and harms over time.
“Although Ireland was not among the participating countries, the large European sample and rigorous design of this multicentre study make its findings broadly relevant to men aged 55 to 69 years across comparable European populations. Ireland currently has no population-wide PSA screening programme, with PSA testing performed opportunistically in primary care and men with raised PSA levels referred to Rapid Access Prostate Clinics for further assessment.
“These findings are consistent with European and Irish guidelines, which emphasise a balanced approach to prostate cancer screening. Moving toward more personalised, risk-based methods may help maximise clinical benefit while minimising overdiagnosis and unnecessary interventions.”
Dr Richéal Burns, Director of the HEAL Research Centre, Atlantic Technical University, comments:
“The new findings from the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 23 years of follow-up, offer further support that early detection is key in reducing the risk of morbidity and mortality. The latest estimates highlight that to prevent one prostate cancer death, 455 mean would need to be ‘screened.’
“With the EU Council advocating since 2022 for introducing PSA testing for men and appropriate follow-up if results are higher than acceptable thresholds, the publication of the 23 year follow-up compounds the need for early detection strategies. Prostate cancer remains the most common male cancer in Ireland with on average 605 men dying annually.
“An economic evaluation on whether or not Ireland should introduce a population-level screening programme for prostate cancer using PSA-testing as a screening mechanism was undertaken by an academic partnership between formerly NUIG, NCRI,NCCP, University of Oxford from 2010-2014 under Prof Linda Sharp, Newcastle University and Prof Ciaran O’Neill, QUB. The outcome of this evaluation by Burns et al, highlighted high uncertainty in understanding the benefits of early detection relative to the harms associated with overdiagnosis and overtreatment which had a significant impact on men’s quality of life. This uncertainty was driven primarily from limitations on data availability at the time of the modelling exercise in 2013. However, under rigorous sensitivity analysis, the economic model suggested that a once-off PSA-test for all men at age 50 or 55 years, yielded evidence of reducing mortality risk and cost-effectiveness. This would also provide a baseline PSA level that could assist with earlier diagnosis in the future.
“Ireland is currently one of the five pilot sites for the European PRAISE-U study on screening for prostate cancer which commenced at the end of 2024. This study will provide valuable evidence to further assist in how a national screening programme for the secondary prevention of prostate cancer should be implemented in Ireland. All evidence highlights we can reduce mortality and the 605 deaths annually in Ireland with early detection; the only question we need to build an evidence base on is what is the most efficient way of detection.”
Conflict of interest: Funded in 2010-2013 by a HRB grant, to undertake a cost-effectiveness analysis of introducing PSA-based screening for the secondary prevention of prostate cancer in Ireland.
Mr David Galvin, Consultant Urologist, Mater and St Vincents hospitals & Lead Investigator of the Irish Pilot of the PRAISE-U study, comments:
“Today’s publication in the New England Journal of Medicine demonstrates the long-term benefits of a population based, PSA based, prostate cancer screening program. Fundamentally, where there is no evidence to support the current opportunistic PSA testing that occurs in Ireland and other countries, the ERSPC study continues to demonstrate the long-term benefits of an organised screening program, which have become clearer as the data has matured. The men in this study had their PSA tested on a 3 yearly basis, reducing their death from prostate cancer by 13%. Sub-groups demonstrated higher reductions in mortality and large reductions in advanced or metastatic disease, which is a costly condition to treat.
“With our rapidly ageing population, and rising medical costs, this is an extremely important issue that Governments need to address. At present, the methods by which we best do this, are being studied in 5 pilot programs, in Ireland, Spain (x2), Portugal and Latvia in an EU funded program, called PRAISE-U which is due to report at the EAU meeting in London in March. The National Cancer program (NCCP) and National Screening service (NSS) are both involved in this program.”
Declared interests:
Dr Amirhossein Jalali: None
Dr Richéal Burns: Funded in 2010-2013 by a HRB grant, to undertake a cost-effectiveness analysis of introducing PSA-based screening for the secondary prevention of prostate cancer in Ireland.
Mr David Galvin: None, other than my current role as Lead Investigator in the Irish pilot of the PRAISE-U study. I have previously published in support of prostate cancer screening.