May 15, 2026

expert reaction to updated Cochrane review into whether prostate cancer screening reduces deaths

An updated review published in Cochrane Database of Systematic Reviews looks at prostate cancer screening and mortality. 

Dr Adam Brentnall, Reader in Biostatistics, Queen Mary, University of London (QMUL), said:

Does the press release accurately reflect the science?

“This review draws on high-quality primary research. The press release accurately reflects the main finding that longer follow-up from randomised controlled trials gives us a clearer picture of PSA screening’s effect on prostate cancer deaths.”

Is this good quality research?  Are the conclusions backed up by solid data?

“The main conclusions have two important limitations.

“1. The benefits are calculated based on all men invited to screening, not those who actually received a PSA test. For men trying to make an informed decision about screening, that distinction matters because the true benefit of actually being screened is likely higher than the figures quoted suggest.

“2. Overdiagnosis is one of the most important harms of screening, and it requires long follow-up after the last screen to measure accurately. The European trial data used in the conclusions had a median follow-up of only 8 years from the last screen, which is not long enough. Evidence from the UK CAP trial, which tracked men for a median of 15 years after screening, tells a more nuanced story – overdiagnosis is likely considerably lower in younger men than this review implies, but considerably higher in men over 70, where remaining life expectancy is shorter. Based on the CAP trial, previous research estimated that around 84% of men diagnosed through screening at age 50 would have been diagnosed clinically anyway (without screening) within 15 years.[1] Put another way, if screening detects cancer in 1% of men screened, then for every 1,000 men screened at age 50, approximately 1.6 cancers would be detected that would otherwise have gone undiagnosed for at least 15 years.”

Have the authors accounted for confounders?  Are there important limitations to be aware of?

“There are some further limitations to the analysis conducted.

“Some of the meta-analyses in this review combine data from trials that are too different to be meaningfully pooled. For instance, mixing trials to estimate excess incidence, where many control-arm participants also got screened with trials where few in the intervention arm did. That makes the combined results difficult to interpret.

“The conclusion that there is no to little effect of a reduction in late stage cancer diagnosis, based on evidence across trials, is not supported by the data.

“The quality-of-life findings highlighted in the paper’s summary are based on a measure that excluded men who had actually been diagnosed with prostate cancer. This undermines what those findings can tell us.”

What are the implications in the real world?  Is there any overspeculation?   Does this suggest we should introduce mass screening or do we also need to consider other factors?

“Long-term data from high-quality randomised trials provides key evidence to determine suitability of screening. However, it’s not sufficient on its own to decide whether an organised national screening programme should be introduced. We also need to weigh broader benefits, harms, and costs.

“The trials in the review compared organised screening against no screening at all – but that’s not the reality in the UK, where millions of men already request PSA tests through their GP.  That testing is heavily skewed toward areas of lower deprivation, which has contributed to real inequality in prostate cancer outcomes. The highest rates of PSA testing also currently occur in men over 70. This is precisely the group at greatest risk of overdiagnosis, and the group least likely to benefit in terms of reduced mortality (based on other findings from the European trial). Any decision about organised screening needs to consider what a well-designed programme could achieve relative to today’s disorganised practice, including on health equity and overdiagnosis in older men.

“Clinical practice has also changed since the European trial was conducted. MRI is now routinely used in the diagnostic pathway, and active surveillance has become far more common – both of which have reduced the harms from screening. Newer UK trials like TRANSFORM and IMProVE will help us understand whether modern screening protocols also improve the benefits of screening.”

References:
[1] A. R.Brentnall, M.Rebolj, P.Sasieni, G.Funston, R.Gabe, and A. J.Vickers, “Evaluating the Impact of Age on Prostate Cancer Overdiagnosis Using Long-Term Follow-Up From the CAP Randomised Trial,” International Journal of Cancer (2026): 1–8, https://doi.org/10.1002/ijc.70492.

Dr Lennard Lee, Associate Professor, University of Oxford, said:

“The Cochrane Collaboration is one of the world’s most respected international organisations for evidence-based medicine, recognised for producing some of the highest standards of evidence synthesis in healthcare.

“The quality of this study and its conclusions appear robust. With longer-term follow-up of the trials, a mortality benefit has now emerged. In this analysis, individuals who underwent PSA blood testing had a lower risk of dying from prostate cancer.

“Prostate Cancer is now the most commonly diagnosed cancer in men in the UK, and far too many patients are still diagnosed at a late stage.

“The study shines a light on the United Kingdom’s health system. In the UK, PSA testing is offered to individuals who actively request it. We must ensure this approach does not widen health inequalities, as people with lower awareness of prostate cancer or reduced access to health information may be less likely to undergo testing.”

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

“This is an important study, which provides a robust review of the current clinical trial evidence on PSA screening, consistent with other recent work. We know from past trials that screening based on PSA can save men’s lives, but not nearly enough.  These findings again show that there is some benefit from PSA-based screening, with 2 deaths prevented per 1000 men screened. However, 87% of deaths from prostate cancer still happen, and the review also highlights that the risk of overdiagnosis remains high We know from past trials that screening based on PSA can save men’s lives, but not nearly enough.  These findings again show that there is some benefit from PSA-based screening, with 2 deaths prevented per 1000 men screened. However, 87% of deaths from prostate cancer still happen, and the review also highlights that the risk of overdiagnosis remains high. More research is needed to plug critical evidence gaps and to find the safest and most effective way to screen men for prostate cancer, ensuring the benefits outweigh the harms. Prostate Cancer UK’s TRANSFORM trial is up and running and is designed to find those answers. It will fill gaps left by the last generation of screening trials and will invite more Black men than any other screening trial has ever done, so we can also build the evidence base we need for the group of men who have the most to gain from effective screening. 

“In the meantime, we must ensure that all men at risk of prostate cancer can make informed choice about whether or not to have a PSA blood test, so each man can decide what is best for him. This research shows again that this is not a simple decision, and we must be honest with men about the benefits but also about the potential harms. Prostate Cancer UK’s website and our 30 second online Risk Checker are the best starting point for men to get the balanced, evidence-based information they need make their own choice about what to do next.”

‘Prostate-specific antigen (PSA) test for prostate cancer screening’ by Juan VA Franco et al. was published in Cochrane Database of Systematic Reviews at 01:00 UK time on Friday 15 May 2026. 

DOI: 10.1002/14651858.CD004720.pub4

Declared interests

Dr Matthew Hobbs: No CoIs.

Dr Adam Brentnall: I am a member of the UK National Screening Committee Research and Methodology Group, and a co-investigator on the TRANSFORM trial of prostate cancer screening. Some further potential conflicts are listed on this page: https://www.gov.uk/government/publications/uk-national-screening-committee-register-of-interests/research-and-methodology-group

For all other experts, no reply to our request for DOIs was received.

This Roundup was accompanied by an SMC Briefing.