PSA screening likely prevents about two prostate cancer deaths per 1000 men, a Cochrane review finds

The edition in brief

An abridged Cochrane review updated to November 2025 included six randomised trials with 789,086 men. Based mainly on the lower-bias ERSPC trial, PSA screening likely reduces prostate cancer-specific mortality (RR 0.87, 95% CI 0.80 to 0.95), about two fewer deaths per 1000 men; it may slightly reduce all-cause mortality (RR 0.99, 0.97 to 1.00), with low certainty. Newer PSA-plus-kallikrein-and-MRI screening increased detection, and its mortality effect is not yet known. In 492 ENZAMET participants with digitised tissue, an AI pathology classifier locked in an earlier trial identified a group (64%) in whom enzalutamide roughly halved the risk of death compared with a nonsteroidal antiandrogen (HR 0.50), and a group with little benefit (HR 1.04). A meta-analysis of five retrospective studies (707 patients) found a period without a stent across the diseased segment before robotic ureteral reconstruction or pyeloplasty was associated with higher success (93.5% vs 86.5%). The pearl covers PSA in men taking 5-alpha reductase inhibitors.