Are Prostate Cancer Screenings Necessary? The Pros and Cons

Farmin Shahabuddin, MPH, Shahmir H. Ali, ABD, Brandel France de Bravo, MPH,  and Nicholas J. Jury, PhD

Prostate cancer is the second leading cause of cancer deaths for men in the United States, after lung cancer. One in every eight men will be diagnosed with prostate cancer in his lifetime.1 Most cases are in men 65 and older, and most deaths occur in men 75 and older.2 Annual screenings would seem to be an important way to prevent prostate cancer. However, it may surprise you that many experts, including the U.S. Preventive Services Task Force (USPTF), do not recommend men over 70 to get screened for prostate cancer.3 For men ages 55 to 69, it doesn’t recommend for or against screening, but instead recommends talking to their doctor about whether screening is right for them.

In fact, even if screening leads to a diagnosis of prostate cancer, it often does not require any treatment. Thus, there is currently a hot debate within the medical community: are prostate cancer screenings a good idea, and if so, for which men? This article discusses the available tests and the benefits and harms of getting tested for prostate cancer.

Are Prostate Cancer Screenings Accurate?

Prostate cancer occurs when small tumors develop in the prostate gland, which is an important part of the male reproductive system. Screening can be performed quickly and easily in a physician’s office using either of two tests: a blood test, called prostate-specific-antigen (PSA) test, and the digital rectal exam (DRE), a manual exam of the prostate area.

However, prostate tests can often be inaccurate. Both the PSA and DRE result in many false positives (when the test shows a man has prostate cancer who does not have prostate cancer) and false negatives (when a test shows a man does not have prostate cancer but he actually does have prostate cancer). Using both screening methods together will miss fewer cancers but also increase the number of false positives, which then results in more testing, such as biopsies that involve inserting a needle through the rectum.  Biopsies can possibly result in medical complications.

Researchers are also trying to determine if other types of testing might be more accurate in detecting prostate cancer.  One study of more than 5,500 men examined whether the rate of change in PSA levels when a man has multiple tests over time (also called “PSA velocity”) could improve cancer detection compared to standard (single blood test) PSA and DRE screening tests.4 They found that high PSA velocity often resulted in biopsies that did not improve cancer detection.

Do Prostate Cancer Screenings Save Lives?

Even if prostate cancer tests are not very accurate, wouldn’t screening lead to earlier detection, earlier treatment, and a lower chance of death? Prostate cancer is often curable (90% or better) if detected early. Common treatments like surgery or radiation aim to remove or kill all cancerous cells in the prostate. If not detected and treated early, the cancer may spread beyond the prostate and can be fatal. However, the value of prostate cancer is very controversial.

Research has shown conflicting conclusions.  We examined the best research and found that whether prostate cancer screening saves lives depends on how exactly “screening” is defined, as well as how survival is measured. For example, a study of 76,000 American men aged 55-74 found that men who screened for prostate cancer every year were not any less likely to die of prostate cancer during the 7 years of the study than those receiving “usual care” (defined for most as at least one screening during those years).5,6

In contrast, a different study of 182,000 European men aged 50-75 found that men who received “regular screening” (every 2-4 years, depending on the European country) were less likely to die of prostate cancer during the 13 years of the study than those who did not have any screening.7,8  And yet, the men who were regularly screened did not live longer than those who didn’t, because they died of other causes.  That’s important to know, because the goal of screening is to live longer, not to prevent death from just one particular disease.

Newer research provides additional important information. In a study published in The New England Journal of Medicine in 2025, researchers in Europe followed more than 160,000 men for 23 years to see whether PSA screening saves lives. The study found that 14% of men who underwent an average of 2 PSA tests were diagnosed with prostate cancer, compared to 12% who did not have any screening PSA tests. Despite that small difference, the men in the PSA group were 13% less likely to die from prostate cancer than those who were not screened. 9 Although that is a modest benefit, it is a better result than an earlier version of the same study showed after men were followed for 16 years.

However, those numbers do not tell you what you need to know as a man deciding if PSA screening is important to you, because only 1.6% of the men who did not have PSA screening died of prostate cancer, compared to 1.4% who had PSA screening. The researchers pointed out that deaths from other causes were much higher: about 49% of men in both groups died of other causes, showing that many men who develop prostate cancer may ultimately die from something else. This is why experts point out that prostate cancer is rarely fatal, and many men who develop prostate cancer will die from something else. That raises the question of whether screening does more harm than good.

Why don’t PSA Screening Programs save more lives?

Prostate cancer usually grows so slowly that it is often equally safe to screen only when there are symptoms, rather than screening based on PSA or DRE results.  Symptoms of prostate cancer can include urinary problems, difficulty having an erection, or blood in the urine or semen. If a man has prostate cancer without any symptoms, he may not need to be treated. In fact, experts estimate that half the men who are diagnosed with prostate cancer would not have any symptoms in their lifetime, and 80-85% would not die of the disease within 15 years of diagnosis, even if they were not treated.10 

The New England Journal of Medicine study researchers point out that the complications of prostate cancer treatment, which include erectile dysfunction and incontinence, continue to be a concern, given the relatively small chances that PSA screening will save a man’s life.  The study also found that for every 1,000 men who were screened, about 27 more were diagnosed with prostate cancer that may never have caused symptoms or shortened their lives. The numbers probably would have been higher if the men had undergone more frequent PSA tests, given that, on average, the men in the study only underwent two. More frequent PSAs would be expected to result in more unnecessary biopsies and treatments that carry their own risks, as noted above.

That’s exactly why experts do not agree that screening with a PSA or DRE test saves lives. For men who were diagnosed with prostate cancer, the chances of dying from the prostate cancer within 10 years of diagnosis were about 3 in 10,000 (that’s less than half of one percent), whether the men had a PSA screening or not.11 This means that although a PSA test will detect prostate cancers before any symptoms appear, often those cancers would never have become harmful. Experts say the findings show that PSA screening can save more lives but should be used carefully, focusing on men who are most likely to benefit while avoiding unnecessary testing in those at low risk.

Can Prostate Cancer Screenings Do Harm?

Aside from not providing a significant benefit to many men, prostate cancer screening may actually do some harm. These harms can include 1) inaccurate results leading to unnecessary biopsies and complications, 2) complications and high costs associated with unnecessary treatment, and 3) serious side effects from treatments (such as urinary incontinence and impotence).12 In fact, a 2018 study based on data from 721,718 men across 5 clinical trials estimated that for every 1000 men screened for prostate cancer, screening-related complications will result in 1 person being hospitalized for sepsis, 3 requiring pads for urinary incontinence, and 25 reporting erectile dysfunction.13

These serious side effects from prostate cancer treatment are the reason why many men with prostate cancer choose “active monitoring” instead of treatment.  Active monitoring usually involves visiting a doctor for a PSA test every 6 months and a DRE at least once a year. However, even being asked to actively check on your symptoms during the years after being diagnosed with prostate cancer can have a detrimental psychological impact.  Men who were diagnosed with low-risk prostate cancer who were asked to monitor their symptoms reported significantly higher anxiety than those without cancer or those currently in treatment.14

It is also important to acknowledge that the harms of prostate cancer screening are disproportionately impacting some communities more than others. A 2018 study revealed that Black men were more likely to receive a false-positive PSA test and undergo a biopsy than white men.15 For more information on racial differences in prostate cancer, read our article linked here.

The Bottom Line

Based on the current evidence, U.S. experts continue to conclude that prostate cancer screenings often provide very little benefit and can be harmful.  Doctors and scientists are searching for better tests, such as using family history of prostate cancer to influence the time and frequency of recommended PSA screenings. However, the impact of such efforts on reducing deaths from prostate cancer remains unknown, and so do the likely harms. Therefore, the best thing to do is talk with your doctor about whether getting a prostate cancer screening is truly right for you.

References

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  2. Cancer of the Prostate – Cancer Stat Facts. SEER. Accessed June 29, 2022. https://seer.cancer.gov/statfacts/html/prost.html
  3. US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(18):1901. doi:10.1001/jama.2018.3710
  4. Vickers AJ, Till C, Tangen CM, Lilja H, Thompson IM. An empirical evaluation of guidelines on prostate-specific antigen velocity in prostate cancer detection. J Natl Cancer Inst. 2011;103(6):462-469. doi:10.1093/jnci/djr028
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  6. Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO). Division of Cancer Prevention. Published July 1, 2014. Accessed July 19, 2022. https://prevention.cancer.gov/major-programs/prostate-lung-colorectal-and-ovarian-cancer-screening-trial
  7. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. The Lancet. 2014;384(9959):2027-2035. doi:10.1016/S0140-6736(14)60525-0
  8. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360(13):1320-1328. doi:10.1056/NEJMoa0810084
  9. Bassett, M. (2025, October 29). PSA screening reduces prostate cancer deaths, long-term data show. MedpageToday. https://www.medpagetoday.com/hematologyoncology/prostatecancer/118218
  10. Mulhem E, Fulbright N, Duncan N. Prostate Cancer Screening. afp. 2015;92(8):683-688.
  11. Ilic D, Djulbegovic M, Jung JH, et al. Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. BMJ. 2018;362:k3519. doi:10.1136/bmj.k3519
  12. Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008;358(12):1250-1261. doi:10.1056/NEJMoa074311
  13. Ruane-McAteer E, Porter S, O’Sullivan J, Dempster M, Prue G. Investigating the psychological impact of active surveillance or active treatment in newly diagnosed favorable-risk prostate cancer patients: A 9-month longitudinal study. Psychooncology. 2019;28(8):1743-1752. doi:10.1002/pon.5161
  14. Miller EA, Pinsky PF, Black A, Andriole GL, Pierre-Victor D. Secondary prostate cancer screening outcomes by race in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Screening Trial. The Prostate. 2018;78(11):830-838. doi:10.1002/pros.23540
  15. Miller, E. A., Pinsky, P. F., Black, A., Andriole, G. L., & Pierre-Victor, D. (2018). Secondary prostate cancer screening outcomes by race in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Screening Trial. The Prostate, 78(11), 830–838. https://doi.org/10.1002/pros.23540