A major European study has delivered some of the clearest long-term evidence yet that PSA-based prostate cancer screening can reduce deaths from the disease: but it also underscores the ongoing challenge of over-diagnosis.
The findings come from the European Randomized Study of Screening for Prostate Cancer (ERSPC), a landmark trial launched in the 1990s and recently published in the New England Journal of Medicine (29 October 2025). With more than 160,000 participants across eight European countries: nearly half from Finland: the ERSPC remains the world’s largest prostate cancer screening trial.
PSA Screening Cuts Mortality, but Benefits Fade After Screening Ends
After 23 years of follow-up, the ERSPC reports a 13% relative reduction in prostate cancer mortality among men who were invited to undergo PSA screening. In practical terms, this means that one death was prevented for every 456 men invited for screening.
Interestingly, the benefit grew over time:
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After 16 years, one life was saved per 628 men screened.
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By 23 years, that number improved to 456.
“Long-term follow-up demonstrates that PSA screening can substantially reduce deaths from prostate cancer,” explains Professor Anssi Auvinen, one of the study’s principal investigators from Tampere University. “Yet, the effect starts to wane once screening is discontinued and largely disappears within nine years.”
The Persistent Problem: Overdiagnosis
While PSA screening can detect cancers earlier: including fewer advanced-stage cases: it also picks up many low-risk, slow-growing tumors that may never cause symptoms. Detecting and treating these indolent cancers exposes men to biopsies, surgery, or radiation that may not improve survival but can diminish quality of life.
In the study, 16% of men had elevated PSA in initial testing, yet only 24% of them were ultimately diagnosed with cancer. That gap represents a substantial number of unnecessary tests and procedures.
A Path Forward: Risk-Based Screening
One of the most promising developments since the ERSPC began is the rise of risk-based screening, which combines tools like MRI with PSA results to better identify cancers that actually require treatment.
“Risk-based screening would enable the identification of men who are at the highest risk of developing a clinically significant prostate cancer,” Auvinen notes.
By targeting men most likely to benefit: and sparing others unnecessary testing: risk-based approaches aim to retain the lifesaving potential of PSA screening while reducing harm.
Why This Matters Now
Prostate cancer is the most common cancer among men in Finland and remains one of the leading causes of cancer deaths both nationally and across Europe. Although Finland currently lacks a national screening program, the ERSPC’s latest results are likely to fuel ongoing policy debates.
The full study: European Study of Prostate Cancer Screening: 23-Year Follow-up: is available in the New England Journal of Medicine, offering an in-depth look at the long-term effects of PSA-based screening and the evolving strategies designed to improve it.
