Screening & monitoring · graded by use, two uses
PSA screening for prostate cancer
Prostate cancer deaths, men aged 55 to 69.
At a glance
This is about the PSA blood test to find prostate cancer early. A large European study found about 1 in 5 fewer deaths from prostate cancer over 16 years. A large UK study found a smaller drop after one test. A US study found none, but most men in its comparison group were tested anyway. Screening finds many slow cancers that would never cause harm, and treatment can cause side effects.
- What was measured
- Deaths from prostate cancer and from any cause, and prostate cancers found by grade and stage, in men invited to the PSA blood test.
- How big
- At 16 years, deaths from prostate cancer were 0.18 percentage points lower in men invited to screening, and 570 men had to be invited to prevent one prostate cancer death. The summary gives the gap, not the two group rates.Read from the summary of PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 30824296.
- Who it applies to
- Men aged 55 to 69 in eight European countries, with support from UK men aged 50 to 69 offered a single test. Men over 70, men with urinary symptoms and men at high inherited risk were not the group studied.
- Safety
- PSA screening finds many prostate cancers that would never have caused harm: in the European trial, 18 men were diagnosed for each death prevented. Biopsies and treatment can cause leaking urine and erection problems.
- Compared with
- Usual care with no invitation; in the US trial most men in the comparison group were tested anyway.
- Certainty
- Grade B, resting on: Large randomized trials of PSA screening against usual care.
- What would change this grade
- Could rise to A with: A large randomized trial of repeated PSA screening against no invitation, with low PSA testing in the control arm, prostate cancer death as the prespecified primary outcome, run by a group independent of ERSPC. Who: Men aged 55 to 69 at average risk. Measured: Deaths from prostate cancer, with death from any cause and overdiagnosis reported. Length: At least 15 years of follow-up.
- Cost
- No price recorded yet.
- Sources
- 4 studies cited on this record, listed under Sources.
The B belongs to one of the two uses graded on this record. The other one carries its own letter.
As studied, and the trials
ERSPC (Hugosson et al., Eur Urol, 2019; PMID 30824296): prostate cancer deaths 20% lower at 16 years; 570 men invited to prevent one death. CAP (Martin et al., JAMA, 2024; PMID 38581198): 0.69% against 0.78% at 15 years after a single test invitation, a secondary outcome after a null primary at 10 years. PLCO (Pinsky et al., Cancer, 2017; PMID 27911486): no difference, with an estimated 86% of control men also tested. One large positive trial supported by a second: B.
As studied, and the trials
Death from any cause was not lower in CAP (0.97, 0.94 to 1.01; PMID 38581198) or PLCO (0.977, 0.950 to 1.004; PMID 27911486), and a pooled lifetime analysis estimated 37 days, not significant (Bretthauer et al., 2023; PMID 37639247). Tested, no benefit: D on Route 2 Human randomized trials have been run and did not show benefit on the stated outcome. One of the two routes to the lowest letter on EBL's scale..
Read the grade that matches your goal. How EBL grades by use →
A letter describes the human evidence, not the product, the manufacturer, or the intervention's worth.
See the full evidence record →PSA screening for prostate cancer, graded on deaths from prostate cancer in men aged 55 to 69 invited to PSA screening: what the randomized trials measured, in whom, and what they did not show.
Why this letter
Why this gradeThe reasoning, and what the grade does not cover.
Grade B on prostate cancer deaths in men aged 55 to 69: ERSPC found them 20% lower at 16 years (PMID 30824296), and CAP found them 8% lower at 15 years after one test (PMID 38581198).
WHY NOT ACAP's primary 10-year outcome was null and its 15-year result is a secondary analysis, and PLCO found no difference (PMID 27911486), though most of its control group was also tested. Grade D, tested, on death from any cause: neither of the two trials that report it, CAP and PLCO, found it lower (PMIDs 38581198, 27911486), and a pooled lifetime analysis was not significant (PMID 37639247).
WHAT THIS GRADE DOES NOT COVERscreening pathways that use MRI before biopsy, which the three trials did not test; men over 70; men with urinary symptoms, for whom PSA is a diagnostic test; and men at high inherited risk, such as BRCA2 carriers or men with several affected relatives.
A grade describes the human evidence for a named use. It is not advice, and it is not a judgment on any individual prescription. How the letters are decided →
Evidence notes: randomized trial
Endpoint graded: Deaths from prostate cancer in men aged 55 to 69 invited to PSA screening (hard)
Last reviewed: October 2026
The trial that would change this grade.
Positive trials of this shape from independent research groups would move this entry to A.
Why the current trials fall short
Only ERSPC is positive on its primary outcome (PMID 30824296); the CAP reduction at 15 years is a secondary analysis after a null primary at 10 years (PMID 38581198), and PLCO was null with heavy control arm testing (PMID 27911486). A second independent trial positive on prostate cancer death as its primary outcome would meet the bar for A.
ClinicalTrials.gov, the public registry run by the U.S. National Library of Medicine, lists studies that are recruiting volunteers. The link below searches it for PSA Screening among studies recruiting now. EBL has no relationship with any listed study and receives no payment for this link.
Search recruiting studies of PSA Screening on ClinicalTrials.gov
Dose, form and timing
Measured in the trials: deaths from prostate cancer and from any cause, and prostate cancer diagnoses by grade and stage.
Safety
PSA screening finds many prostate cancers that would never have caused harm: in ERSPC, 18 men were diagnosed for every prostate cancer death prevented at 16 years (PMID 30824296), and in CAP screening added mostly low-grade, localized cancers (PMID 38581198). Diagnosis leads to biopsies and to treatment that can cause incontinence and erectile problems.
Cautions documented in human studies. Each caution on this record, sorted by what it rests on.
- Overdiagnosis: in ERSPC, 18 men were diagnosed for every prostate cancer death prevented, and in CAP screening added mostly low-grade, localized cancers. (PMID 30824296 PMID 38581198)
- Treatment after diagnosis can cause lasting incontinence and erectile problems: in one randomized trial, 18 to 24 percent of men needed pads 7 to 12 years after surgery. (PMID 38320051)
None recorded.
None recorded.
None recorded.
Does not apply: human harm data are listed above.
Sources
- Citations
- Every paper cited on this page is matched to its PubMed record on every build.
- Retractions
- None of these papers is retracted or under a journal expression of concern. PubMed is checked again on every build.
- Read against the papers
- October 2026. By the EBL editor, Arnold Sandlow, DC.
- Outside review
- Not yet done. No reviewer outside EBL has checked this record.
What each of these checks can and cannot show: evidence integrity.
Primary evidenceFour papers, each linked to its PubMed record.
ERSPC (Hugosson et al., Eur Urol, 2019; PMID 30824296): 162,389 men aged 55 to 69 in eight European countries; at 16 years prostate cancer deaths 20% lower (rate ratio 0.80, 0.72 to 0.89), 0.18 percentage points absolute; 570 men invited and 18 diagnosed to prevent one prostate cancer death. CAP (Martin et al., JAMA, 2024; PMID 38581198): 415,357 men aged 50 to 69 at 573 UK practices, one PSA test invitation; primary outcome at 10 years null; at 15 years, a prespecified secondary outcome, prostate cancer deaths 0.69% against 0.78% (0.92, 0.85 to 0.99), more low-grade and localized cancers found, death from any cause 0.97 (0.94 to 1.01). PLCO (Pinsky et al., Cancer, 2017; PMID 27911486): 76,683 US men, annual PSA for 6 years; prostate cancer deaths 255 against 244 (1.04, 0.87 to 1.24) at about 15 years; an estimated 86% of control men also had PSA tests; death from any cause 0.977 (0.950 to 1.004). Bretthauer et al. (JAMA Intern Med, 2023; PMID 37639247): lifetime gained 37 days (-37 to 73), not significant.
Evidence Based Longevity, Inc. is owner-operated and edited by Arnold Sandlow, D.C., a California-licensed chiropractor. Evidence Based Longevity publishes in English only · Machine translations are not produced or reviewed by EBL for accuracy
How EBL searched for the trials (1 search)
The search that was run, what it returned, and what was left out and why, so the absence of evidence can be checked as well as its presence.
(PSA[ti] OR "prostate-specific antigen"[ti] OR prostate[ti]) AND screening[ti] AND randomized controlled trial[pt] AND "prostate cancer mortality"[tiab]PubMed watch: does a new study change the grade? (nothing new)
No new paper matching the search behind this grade has been added to PubMed since October 2026.
Last run October 2026. A letter on EBL moves only after a logged review. A new paper never moves a letter by arriving: it is read, the answer is written here, and any change to the letter is published in the evidence log.
Disclosure
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