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Effect of Implementing Population-Based Prostate-Specific Antigen Screening on Testing Rates and Prostate Cancer
Andrew J Vickers1, Veeru Kasivisvanathan2,3, Adam R Brentnall4
1Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
International Journal of Cancer
|August 10, 2026
Summary
Implementing population-based prostate-specific antigen (PSA) screening in England could significantly reduce PSA testing and overdiagnosis by approximately 25%. This organized approach is likely to improve population health and reduce prostate cancer mortality compared to current opportunistic policies.
Area of Science:
- Oncology
- Public Health
- Health Services Research
Background:
- Current opportunistic prostate-specific antigen (PSA) testing policies in England are associated with high rates of PSA testing and prostate cancer overdiagnosis.
- Overdiagnosis leads to unnecessary treatments and patient anxiety without improving health outcomes.
Purpose of the Study:
- To statistically model the impact of implementing population-based PSA screening in England.
- To compare population-based screening with the current opportunistic testing policy regarding overdiagnosis and PSA testing rates.
- To evaluate the potential effect of organized screening on prostate cancer mortality.
Main Methods:
- Statistical modeling study integrating English epidemiological data (life expectancy, PSA testing rates, prostate cancer incidence by stage) and lead time data.
- Base scenario modeling to assess outcomes of population-based screening versus current policy.
- Sensitivity analyses using an independent modeling approach based on the UK Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP).
Main Results:
- Population-based screening is projected to reduce PSA testing and overdiagnosis by approximately 25% compared to the current opportunistic policy.
- This reduction is driven by a larger decrease in testing and overdiagnosis in men aged 70+ years outweighing increases in men aged 50-69 years.
- Population-based screening detects more early-stage cancers without overdiagnosis, potentially leading to greater reductions in prostate cancer mortality.
Conclusions:
- Opportunistic PSA screening in England results in high testing and overdiagnosis rates.
- A risk-adapted, population-based prostate cancer screening program could decrease PSA tests and overdiagnoses while enhancing the benefits of reduced prostate cancer mortality.
- Adopting an organized PSA screening program and policies to curb opportunistic testing would improve population health in England.
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