Cochrane review finds PSA screening likely reduces prostate cancer deaths

In May 2026, Cochrane researchers updated their review of six trials involving nearly 800,000 men in Europe and North America, finding that PSA blood testing likely reduces prostate cancer deaths. According to the review, the screening modestly lowered the risk by about two fewer deaths per 1,000 men screened, based on moderate-certainty evidence.

The review reported a modest mortality benefit of about two fewer prostate cancer deaths per 1,000 men screened, based on moderate-certainty evidence, according to the Cochrane evidence summary. This represents a change from the group’s 2013 update, which concluded that PSA screening did not significantly reduce prostate cancer mortality.

The updated Cochrane review, published in May 2026, analyzed data from six trials conducted across Europe and North America, involving nearly 800,000 men, and found that prostate-specific antigen (PSA) blood testing likely reduces the risk of dying from prostate cancer.

One major trial contributing to the updated analysis followed 162,241 men for 23 years, providing longer-term follow-up data than previous reviews, according to Cochrane records and reporting by STAT. Juan Franco, the review’s first author and a researcher at Heinrich Heine University Düsseldorf, told STAT that the group now has “moderate certainty” that PSA screening reduces disease-specific deaths. Cochrane officials said the mortality benefit emerges only with longer-term follow-up, emphasizing the importance of extended observation periods in evaluating screening outcomes.

The review also indicates that PSA screening may reduce the risk of dying from any cause, though this evidence is less certain. Cochrane noted that approximately 500 men would need to be invited to screening to prevent one prostate cancer death. The overall effect is described as modest, with Cochrane officials cautioning that the reduction in deaths is small in absolute terms.

In addition to mortality benefits, the review found that PSA screening increases the number of prostate cancers detected. Cochrane reported that screening likely results in 36 more men diagnosed with any prostate cancer per 1,000 screened and 34 more men diagnosed with localized prostate cancer per 1,000 screened. The Imaging Wire cited the review’s findings of a roughly 30% increase in prostate cancer diagnoses overall, mostly at an early stage. The review also suggested that PSA screening may reduce the number of metastatic prostate cancers by about five fewer cases per 1,000 men screened.

Cochrane officials acknowledged that the screening benefit comes with a substantial risk of overdiagnosis. The review found that for every one to two prostate cancer deaths prevented, there are about 36 additional cancers diagnosed. This tradeoff was similarly noted by The Imaging Wire. The review also stated that PSA screening may make little to no difference in deaths related to biopsy procedures or prostate cancer treatment. Evidence on quality of life showed little to no difference in the limited data available, according to Cochrane.

Experts from the Science Media Centre commented that the review draws on high-quality primary research and described the conclusion as robust. They also highlighted that the mortality benefit became apparent only with longer-term follow-up. Cochrane’s announcement framed the updated findings as a shift from its previous conclusions, reflecting the impact of extended data collection.

Clinically, Cochrane said PSA screening likely reduces prostate cancer deaths primarily in men with sufficient life expectancy. The review noted that newer approaches combining PSA with additional blood markers and prostate imaging might detect more cancers, but their effect on mortality remains unclear. The updated evidence supports a role for PSA screening in practice while underscoring the need to balance benefits with the risk of overdiagnosis and to use screening carefully.

The broader evidence base still leaves open questions about the optimal screening strategy, particularly regarding how to balance the modest mortality benefit against harms from overdiagnosis and overtreatment. Cochrane’s 2026 update builds on previous reviews by incorporating longer-term follow-up and larger sample sizes, contributing to ongoing discussions about prostate cancer screening policies in Europe and North America.