Implications of Prolonged PSA Screening on Prostate Cancer Outcomes: Insights from the ERSPC

In a 23-year follow-up study published in The New England Journal of Medicine, organized PSA screening produced a 13% relative reduction in prostate cancer mortality (1.4% in the screened group vs 1.6% in controls), a roughly 0.22% absolute decrease.

The large, randomized, organized screening program used protocolized PSA testing with predefined follow-up and biopsy triggers across multiple European centers; the prespecified primary endpoint was prostate cancer mortality. Framed as absolute outcomes, the screening arm’s 0.22% absolute reduction equates to about one death prevented per 456 invitations.

Over time, the benefit-to-harm ratio improved. Early rounds disproportionately detected low-risk disease, increasing incidence, but cumulative follow-up shows a growing absolute mortality reduction with smaller excess incidence. Active surveillance for low-risk tumors reduces intervention-related harms while retaining the screening benefit for life-threatening cancers.

Compared with other major screening trials that produced mixed early signals, extended ERSPC follow-up clarifies a net mortality advantage when testing is repeated and protocolized. Overall, these findings point to personalized, risk-based screening schedules as the next step to maximize survival gains while minimizing harms.