Prostate cancer screening: revisiting evidence after 23 years of ERSPC follow-up

The 23-year ERSPC follow-up provides strong evidence that standardized PSA-based screening can modestly reduce prostate cancer mortality when implemented in a well-designed, harmonized multicenter setting. The study exemplifies the importance of assay standardization and methodological rigor in producing reliable data applicable to clinical and public health decision-making. However, the findings also reinforce the concept that PSA screening should not be applied indiscriminately. The benefits of PSA-based screening in reducing prostate cancer–specific mortality become evident in the ERSPC after approximately 9 to 11 years of follow-up. These findings underscore the importance of targeting screening efforts toward populations with an anticipated life expectancy of at least 10 years. To this end, future strategies should move toward risk-adapted and precision-based models that integrate molecular biomarkers, imaging modalities, and individual risk profiling to optimize the balance between benefits and harms.