Key messages

• Screening for prostate cancer using a blood test likely reduces the risk of dying from prostate cancer and may also reduce the risk of dying from any cause. Screening likely makes little to no difference in the diagnosis of advanced prostate cancer but may reduce the diagnosis of metastatic prostate cancer (cancer that has spread to other body parts).
• Screening likely increases the number of men diagnosed with any prostate cancer, as well as early-stage cancer, placing some at risk of being diagnosed and treated for cancers that may not matter during their lifetime.
• A newer screening approach that combines the standard blood test with a wider set of blood test markers and prostate imaging likely finds more prostate cancers, but whether it reduces deaths from prostate cancer or any cause is unclear.

What is prostate cancer screening?

Prostate cancer develops in the prostate, a small gland below the bladder that makes fluid for semen. It is one of the most common types of cancer in men, mainly affecting men aged over 50. If caught early, it can usually be treated successfully. Screening tests are designed to diagnose prostate cancer in the early stages where there may be no symptoms or before slow-growing cancers cause problems.

The ‘PSA’ (prostate-specific antigen) blood test looks for high PSA levels in the blood, which can indicate prostate cancer. The next step for men with high PSA is a biopsy, where a small tissue sample is removed and tested for cancer. Treatments such as surgery or radiation are then given. But these treatments may cause unwanted effects, such as leaking urine or having to urinate too often, difficulties with erections, and bowel problems.

What did we want to find out?

We aimed to find out if screening for prostate cancer using PSA in men without any cancer symptoms reduces their risk of dying from prostate cancer or other causes. We also wanted to find out if PSA testing:

• causes any harm;
• affects men's quality of life; and
• has any impact on how often prostate cancer is diagnosed, and whether diagnoses occur when cancer is localised (only in the prostate gland), advanced (grown beyond the prostate gland), or has spread to other parts of the body (metastasised).

What did we do?

We searched for studies that compared PSA screening to no screening in men with no cancer symptoms. We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and numbers of men included.

What did we find?

We found six studies involving 789,086 men, most of whom were White. The studies were conducted in Canada, Europe, and the USA. The men were between 45 and 80 years old and were followed for 3.2 to 23 years.

Main results

PSA testing:

• likely reduces the risk of dying from prostate cancer over 23 years of follow-up: 2 fewer men die of prostate cancer per 1000 men screened (evidence from 1 study with 162,241 men);
• may reduce the risk of dying from any cause: 5 fewer men die of prostate cancer per 1000 screened (4 studies, 675,121 men);
• may make little to no difference to the number of men who experience serious harmful, unwanted events, defined as deaths from biopsy or prostate cancer treatment (1 study, 408,721 men);
• may result in little to no difference in men's quality of life (1 study, 969 men).

For prostate cancer diagnoses, evidence from 1 trial with 162,236 men shows that PSA testing:

• likely increases the numbers of men diagnosed with any prostate and localised prostate cancer: 36 more men are diagnosed with any prostate cancer and 34 more men with localised cancer per 1000 men screened;
• likely makes little to no difference to advanced prostate cancer diagnoses;
• may reduce the number diagnosed with metastatic cancer: 5 fewer men per 1000 screened.

We did not find evidence on other unwanted effects of screening, including problems related to biopsies (e.g. serious infections or hospital admissions) or treatments (e.g. urinary problems, erection difficulties, bowel problems).

One study, involving 60,745 men, examined a combination of the standard blood test plus a wider set of blood tests and prostate imaging. This approach likely has little to no effect on the number of men diagnosed with prostate cancer, including both early and advanced stages. This study did not report whether testing affected the number of deaths.

What are the limitations of the evidence?

We are moderately confident in the evidence from one large, well-conducted, long-running study. We have lower confidence in the evidence from the other five studies due to concerns about how they were conducted and differences in their results.

This review provides little information about the unwanted effects of screening because the studies we considered do not typically collect this information, especially delayed or infrequent unwanted effects.

How up to date is this evidence?

This updates our previous review published in 2013. The evidence is current to 19 November 2025.