#2-43E. ERSPC Final Report: Long-Term Evidence for PSA Screening Mortality Reduction (NEJM, 2025)

Given that prostate cancer mortality is projected to double globally by 2040, what is the true long-term impact of population-based PSA screening? This final report from the multicenter European Randomized Study of Screening for Prostate Cancer (ERSPC) assessed 162,236 men (ages 55–69) over a median follow-up of 23 years. The study confirms that prostate-specific antigen (PSA) screening resulted in a sustained 13% reduction in prostate cancer mortality compared to the control group. Crucially, this extended follow-up reveals an improved harm-to-benefit profile, reflected by a favorable reduction in the Number Needed to Diagnose (NND) to prevent one death, which decreased from 18 to 12 men. However, this clear benefit must be assessed alongside the persistent concern of overdiagnosis, highlighted by the doubling of low-risk cancer detection in the screening arm. For clinicians, these data underscore the importance of moving toward risk-based screening strategies to minimize unnecessary interventions while maximizing the life-saving potential of early detection.

Citation: Roobol MJ, de Vos II, Månsson M, et al. European Study of Prostate Cancer Screening — 23-Year Follow-up. The New England Journal of Medicine. 2025. DOI: 10.1056/NEJMoa2503223

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