The Effectiveness and Harms of PSA-Based Prostate Cancer Screening: A Systematic Review

Prostate cancer's prevalence is rapidly increasing in Korea, with incidence rates rising by over 13% annually since 2017 according to the Korea Central Cancer Registry, highlighting the need for effective early detection strategies. This study systematically reviews the benefits and harms of PSA-based prostate cancer screening, focusing on its clinical effectiveness and public health implications.

Following PRISMA 2020 guidelines, we searched five databases (PubMed, Embase, Cochrane Library, Google Scholar, and KMbase) for studies from 2014 to 2024. The eligible studies included RCTs, cohort studies, meta-analyses, and guidelines. Risk of bias was assessed using the Cochrane tool. We synthesized our findings narratively due to their methodological heterogeneity.

Sixteen studies were included. PSA screening reduced prostate-cancer-specific mortality by 20-31%, as reported in multiple randomized controlled trials, such as ERSPC and ProScreen, among men aged 55-69, but showed minimal impact on all-cause mortality. Advanced tools such as MRI and multi-biomarker models, which were implemented in several included studies, enhanced diagnostic accuracy. The potential harms included overdiagnosis, overtreatment, and psychological distress. Community-based education and shared decision-making, inferred from observational and implementation studies, improved participation and equity in screening.

PSA-based screening offers modest mortality benefits but carries the risk of overdiagnosis. Precision diagnostics and risk-stratified strategies improve screening outcomes. Public health approaches, particularly those led by nurses and community health workers, are essential to promoting informed, equitable screening decisions.