Experts advise against routine screening for prostate cancer

Routine testing for prostate cancer is not recommended for most men because the benefit is small and uncertain and there are clear harms, say a panel of international experts in The BMJ.

The experts acknowledge, however, that some men, such as those with a family history of prostate cancer, may be more likely to consider screening and, for these men, discussions about possible harms and benefits with their doctor is essential.

The experts’ advice is based on the latest evidence and is part of The BMJ’s Rapid Recommendations initiative – to produce rapid and trustworthy guidance based on new evidence to help doctors make better decisions with their patients.

The prostate specific antigen (PSA) test is the only widely used test currently available to screen for prostate cancer. It is used in many countries, but remains controversial because it has increased the number of healthy men diagnosed with and treated unnecessarily for harmless tumours.

So an international panel, made up of clinicians, men at risk of prostate cancer, and research methodologists, carried out a detailed analysis of the latest evidence.

Based on a review – more than 700,000 men in clinical trials – which found that if screening reduces prostate cancer deaths at all, the effect is very small, the panel advises against offering routine PSA screening and says most well informed men will decline screening because of the small and uncertain benefits and the clear harms.

“Clinicians need not feel obligated to systematically raise the issue with all their patients, and should engage in shared decision making for those considering screening“, says the chair of the new guideline, Dr. Kari Tikkinen from the University of Helsinki and Helsinki University Hospital.

Men at higher risk of prostate cancer death – for example, those with a family history of prostate cancer or of African descent – may be more likely to choose PSA screening after discussion of potential benefits and harms of testing with their doctor, authors concluded.

This view is supported in a linked editorial by Professor Martin Roland at the University of Cambridge and colleagues.

For more information:

Rapid Recommendation:
Kari Tikkinen, Adjunct Professor, Academy of Finland Clinical Researcher
University of Helsinki and Helsinki University Hospital, Departments of Urology and Public Health

David Neal, Professor of Surgical Oncology, University of Oxford, UK
Tel: +44 (0)7850 570 698

Richard Buckley, Patient living with prostate cancer
Tel: +44 (0)7990 836 802


Prostate specific antigen (PSA) screening for prostate cancer: a clinical practice guideline. Kari A O Tikkinen & al, The BMJ, 5th Sept, 2018. 

Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis.  Dragan Ilic & al, The BMJ, 5th Sept, 2018.

What should doctors say to men asking for a PSA test? Martin Roland & al, The BMJ, 5th Sept, 2018.