A claim you hear on longevity podcasts

Does PSA screening lower the risk of dying from prostate cancer?

Conflicting. Of 8 studies that count, 5 agree, 2 disagree and 1 partly agrees. 2 more are not counted.

Best for:: men deciding whether to get regular PSA screening.
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The claim checked: PSA screening every two to four years cut prostate cancer deaths by 20 to 25% in the trials Hear it at 14:02

What do the studies say?

Conflicting

The European trial (ERSPC), the Swedish Göteborg trial and the pooled reviews that lean on them find fewer prostate cancer deaths with repeated screening. The US PLCO trial, in which many men in the control arm were also tested, and an older 2010 meta-analysis found no significant drop.

Computed from 8 studies that test this point, each judged by two readers, in full. 2 more studies are shown with a hollow dot and do not count. Sources land on both sides. 2 more studies are waiting for a full read and do not count yet.

What was said on the podcast?

“all the trials that showed that screening for prostate cancer with the PSA test those trials had tested whether or not that reduced deaths which they showed it did by 20 to 25% was PSA testing every two to four years”

Ted Schaeffer, a guest on The Peter Attia Drive · What to do if your PSA test is abnormal | Peter Attia & Ted Schaeffer · 14:02 on YouTube
A clip of episode #273 (full episode poTcAm_rknw). He names no trial; ERSPC matches his description.

The study behind the claim The retelling matches it

What did the study actually test?

He names no trial on tape. ERSPC is the trial that matches his figures and screening interval. A 16-yr Follow-up of the European Randomized study of Screening for Prostate Cancer. Eur Urol, 2019. Multicentre randomised screening trial in eight European countries, 162,389 men aged 55 to 69.

What was saidWhat the study did

What was given Matches PSA testing every two to four years Repeated PSA invitations, every 4 years in most centres and every 2 years in Sweden and France (Belgium every 7 years).

Compared with Matches No screening Men randomised to the control arm and not invited to screening.

What was measured Matches Deaths from prostate cancer Prostate cancer mortality, the primary outcome.

Who took part Matches Men Men aged 55 to 69 in eight European countries.

What it found

“The RR of PCa mortality between the arms was 0.80 at 16 yr (95% CI 0.72–0.89, p < 0.001) and did not change compared with 9, 11, and 13 yr of follow-up (Table 3).”

PMID 30824296

How the authors extend it

“Findings corroborate earlier results that PSA screening significantly reduces PCa mortality, showing larger absolute benefit with longer follow-up and a reduction in excess incidence.”

PMID 30824296

The funding statement names Hybritech Inc.; the corresponding author declares no conflicts. Two readers agreed on the label, and the paper was read in full.

Point 1 of 2 Conflicting

PSA screening repeated every two to four years reduces deaths from prostate cancer.

Agree 6

controlled trial · 2019 · landmark · cited on tape

“Findings corroborate earlier results that PSA screening significantly reduces PCa mortality, showing larger absolute benefit with longer follow-up and a reduction in excess incidence.”

A 16-yr Follow-up of the European Randomized study of Screening for Prostate Cancer. Eur Urol
Who: 182,160 men randomised in eight European countries (ERSPC), core age group 162,389 men aged 55-69 from population registries; French data excluded from the combined analysis
PMID 30824296

controlled trial · 2022 · landmark

“Prostate specific antigen-based screening substantially decreases PC mortality.”

Results from 22 years of Followup in the Göteborg Randomized Population-Based Prostate Cancer Screening Trial. J Urol
Who: 20,000 men born 1930-1944 drawn from the Göteborg population register, randomised 1:1 to biennial PSA screening or control (106 excluded after randomisation)
PMID 35422134

pooled analysis · 2026 · landmark

“Screening likely reduces prostate cancer‐specific mortality and may reduce overall mortality.”

Prostate-specific antigen (PSA) test for prostate cancer screening. Cochrane Database Syst Rev
Who: 6 RCTs of men aged 45-80 in Europe and North America (CAP, PLCO, ERSPC, Quebec, Stockholm and one PSA/kallikrein/MRI trial) with no prior prostate cancer diagnosis
PMID 42134821

Show 3 more Show fewer

pooled analysis · 2018 · landmark

“At the same time, it probably modestly reduces prostate cancer specific mortality but has no effect on overall mortality.”

Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. BMJ
Who: 5 RCTs of PSA screening vs control in men (CAP, ERSPC core group, PLCO, Göteborg, Quebec); Norrköping excluded
PMID 30185521

other primary study · 2017

“After accounting for differences in implementation and settings, the ERSPC and PLCO provide compatible evidence that screening reduces PC mortality.”

Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials. Ann Intern Med
Who: individual records of men aged 55-69 (ERSPC) and 55-74 (PLCO) at randomization in the two RCTs, analysed jointly with CISNET models
PMID 28869989

pooled analysis · 2026 · read from the abstract

Not counted. Read from the abstract. It could change the badge, so it counts once read in full.

“With 11-23 yr of follow-up, high-certainty evidence demonstrates that PSA-based PCa screening is associated with reduced PCSM among individuals who engage in screening-a finding that contrasts with earlier evidence syntheses.”

Effect of Prostate Cancer Screening with Prostate-specific Antigen Testing on Long-term Prostate Cancer-specific Mortality: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur Urol
Who: 5 RCTs of PSA-based screening vs no screening or usual care in adults with prostates aged 45-80
PMID 42091407

Partly agree 2

controlled trial · 2011

“The risk ratio for prostate cancer specific death did not indicate significant benefit from prostate cancer screening.”

Randomised prostate cancer screening trial: 20 year follow-up. BMJ
Who: 9,026 men aged 50-69 in Norrköping, Sweden; 1,494 allocated to screening (every sixth man by date of birth), 7,532 controls
PMID 21454449

systematic review · 2018 · read from the abstract

Not counted. Read from the abstract. It could change the badge, so it counts once read in full.

“PSA screening may reduce prostate cancer mortality risk but is associated with false-positive results, biopsy complications, and overdiagnosis.”

Prostate-Specific Antigen-Based Screening for Prostate Cancer: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA
Who: 63 studies (RCTs of screening, cohorts of harms, treatment trials); screening RCTs: a US trial (n = 76,683), a UK single-screen trial (n = 408,825) and a European trial (n = 162,243)
PMID 29801018

Disagree 2

controlled trial · 2019 · landmark

“After almost 17 years median follow-up, there was no significant reduction in prostate cancer mortality in the intervention compared to usual care arm.”

Extended follow-up for prostate cancer incidence and mortality among participants in the Prostate, Lung, Colorectal and Ovarian randomized cancer screening trial. BJU Int
Who: 76,683 US men aged 55-74 at 10 PLCO screening centres, randomised 1993-2001 to screening or usual care
PMID 30288918

pooled analysis · 2010

“In this systematic review and meta-analysis of prostate cancer screening we failed to find a significant impact of prostate cancer screening on overall mortality or death from prostate cancer, the most critical outcomes for patients.”

Screening for prostate cancer: systematic review and meta-analysis of randomised controlled trials. BMJ
Who: 6 RCTs of screening by PSA with or without DRE vs no screening in men with no prior prostate cancer (ERSPC, PLCO, French ERSPC, Gothenburg, Quebec, Norrköping)
PMID 20843937

Point 2 of 2 Leaning for

In the trials, PSA screening every two to four years reduced prostate cancer deaths by about 20 to 25%.

ERSPC at 16 years and Göteborg reach that size, and a model that reconciles ERSPC and PLCO puts it at 25 to 31%. The pooled reviews give smaller drops, and ERSPC's own 23-year update gives 13%.

Computed from 7 studies that test this point, each judged by two readers, in full. 2 more studies are shown with a hollow dot and do not count. 2 more studies are waiting for a full read and do not count yet.

Agree 3

controlled trial · 2019 · landmark · cited on tape

“The rate ratio of PCa mortality was 0.80 (95% confidence interval [CI] 0.72–0.89, p < 0.001) at 16 yr.”

controlled trial · 2022 · landmark

“Compared with the CG, the SG showed a PC incidence rate ratio (RR) of 1.42 (95% CI, 1.31–1.53) and a PC mortality RR of 0.71 (95% CI, 0.55–0.91).”

other primary study · 2017

“Using the formula 1–HRMLT, this would translate into an estimated 25–31% and 27–32% reduction in the expected risk of prostate cancer death in the setting of screening as performed in the ERSPC and PLCO intervention arms, respectively, over 11 years of follow-up relative to no screening.”

Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials. Ann Intern Med
Who: Individual records of men aged 55-69 (ERSPC) or 55-74 (PLCO) at randomization
PMID 28869989

Partly agree 5

controlled trial · 2011

“The confidence interval of the risk ratio was narrow enough to conclude that screening and treatment of men with tumours detected through screening as practised in the present study is unlikely to reduce mortality from prostate cancer by more than a third.”

pooled analysis · 2026 · landmark

“Screening likely results in a reduction in prostate cancer‐specific mortality (sensitivity analysis from ERSPC: Rate Ratio 0.87, 95% CI 0.80 to 0.95; 1 study, 162,236 participants; moderate‐certainty evidence; MCID: 1 per 1000 participants).”

pooled analysis · 2018 · landmark

“PSA screening may have little or no effect on prostate cancer-specific mortality based on five trials reporting this outcome (IRR 0.96 (0.85 to 1.08), I 2 =58%, low quality evidence; fig 4 , table 2 ).”

Show 2 more Show fewer

systematic review · 2018 · read from the abstract

Not counted. Read from the abstract. It could change the badge, so it counts once read in full.

“Randomization to PSA screening was not associated with reduced risk of prostate cancer mortality in either a US trial with substantial control group contamination (n = 76 683) or a UK trial with low adherence to a single PSA screen (n = 408 825) but was associated with significantly reduced prostate cancer mortality in a European trial (n = 162 243; relative risk [RR], 0.79 [95% CI, 0.69-0.91]; absolute risk reduction, 1.1 deaths per 10 000 person-years [95% CI, 0.5-1.8]).”

pooled analysis · 2026 · read from the abstract

Not counted. Read from the abstract. It could change the badge, so it counts once read in full.

“PSA-based screening, with a high certainty in the evidence, demonstrated a reduced risk of PCSM at the longest follow-up (p < 0.001).”

Disagree 1

pooled analysis · 2010

“With the inverse variance method, the calculated relative risk was 0.88 (0.71 to 1.09; P=0.25) when analysed in an intention to screen analysis (fig 2).”

What else was said but not tested?

Annual PSA testing is more intensive than what the trials did

More on lifestyle and genes

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Does PSA screening lower the risk of dying from prostate cancer?

What do the studies say?

What was said on the podcast?

What did the study actually test?

PSA screening repeated every two to four years reduces deaths from prostate cancer.

Agree 6

Partly agree 2

Disagree 2

In the trials, PSA screening every two to four years reduced prostate cancer deaths by about 20 to 25%.

Agree 3

Partly agree 5

Disagree 1

What else was said but not tested?

More on lifestyle and genes

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