PSA testing and prostate cancer early detection

Overview

Australia runs no organised PSA screening programme: testing happens through informed choice, one man at a time, in general practice. That makes the pre-test conversation the highest-yield moment in the whole pathway. The AUA/SUO guideline puts it plainly — PSA-based screening in combination with shared decision-making is recommended, with longer intervals and tailored screening based on risk data, and online risk calculators encouraged.^[19]

The evidence base is now mature enough for that conversation to be honest. ERSPC's final 23-year analysis confirms a real mortality benefit with an improving harm-benefit ratio over time, while quantifying overdiagnosis precisely. ProtecT defines what a diagnosis leads to: three management strategies with near-identical survival but very different functional lives. This topic is the GP managing both conversations well.^[1][3]

References22ShowHide

1. [1]Roobol MJ, de Vos II, Månsson M et al. European Study of Prostate Cancer Screening - 23-Year Follow-up. The New England journal of medicine, 2025.PMID 41160819
2. [2]Schröder FH, Hugosson J, Roobol MJ et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet (London, England), 2014.PMID 25108889
3. [3]Hamdy FC, Donovan JL, Lane JA et al. Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. The New England journal of medicine, 2023.PMID 36912538
4. [4]Hamdy FC, Donovan JL, Lane JA et al. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. The New England journal of medicine, 2016.PMID 27626136
5. [5]Donovan JL, Hamdy FC, Lane JA et al. Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. The New England journal of medicine, 2016.PMID 27626365
6. [6]Donovan JL, Hamdy FC, Lane JA et al. Patient-Reported Outcomes 12 Years after Localized Prostate Cancer Treatment. NEJM evidence, 2023.PMID 38320051
7. [7]Ahmed HU, El-Shater Bosaily A, Brown LC et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet (London, England), 2017.PMID 28110982
8. [8]Hugosson J, Månsson M, Wallström J et al. Prostate Cancer Screening with PSA and MRI Followed by Targeted Biopsy Only. The New England journal of medicine, 2022.PMID 36477032
9. [9]Englman C, Maffei D, Allen C et al. PRECISE Version 2: Updated Recommendations for Reporting Prostate Magnetic Resonance Imaging in Patients on Active Surveillance for Prostate Cancer. European urology, 2024.PMID 38556436
10. [10]Vale CL, Fisher D, Kneebone A et al. Adjuvant or early salvage radiotherapy for the treatment of localised and locally advanced prostate cancer: a prospectively planned systematic review and meta-analysis of aggregate data. Lancet (London, England), 2020.PMID 33002431
11. [11]Thompson IM, Goodman PJ, Tangen CM et al. The influence of finasteride on the development of prostate cancer. The New England journal of medicine, 2003.PMID 12824459
12. [12]Andriole GL, Bostwick DG, Brawley OW et al. Effect of dutasteride on the risk of prostate cancer. The New England journal of medicine, 2010.PMID 20357281
13. [13]McHugh JK, Bancroft EK, Saunders E et al. Assessment of a Polygenic Risk Score in Screening for Prostate Cancer. The New England journal of medicine, 2025.PMID 40214032
14. [14]Brentnall AR, Rebolj M, Sasieni P et al. Evaluating the Impact of Age on Prostate Cancer Overdiagnosis Using Long-Term Follow-Up From the CAP Randomised Trial. International journal of cancer, 2026.PMID 42015666
15. [15]Remmers S, Bangma CH, Godtman RA et al. Relationship Between Baseline Prostate-specific Antigen on Cancer Detection and Prostate Cancer Death: Long-term Follow-up from the European Randomized Study of Screening for Prostate Cancer. European urology, 2023.PMID 37088597
16. [16]Cirulli GO, Davis M, Stephens A et al. Midlife baseline prostate-specific antigen, velocity, and doubling time association with lethal prostate cancer and mortality. Cancer, 2025.PMID 39377255
17. [17]Sheikh SR, Castanon A, Mathews C et al. Association of asymptomatic PSA testing on prostate cancer mortality; a case control study in general practice. BJGP open, 2026.PMID 42320978
18. [18]Vickers AJ, Cooperberg M, Pavlovich CP et al. Prostate Cancer Mortality After Relabeling Low-Grade Prostate Cancer as Precancerous. JAMA oncology, 2026.PMID 42166158
19. [19]Wei JT, Barocas D, Carlsson S et al. Early Detection of Prostate Cancer: AUA/SUO Guideline Part I: Prostate Cancer Screening. The Journal of urology, 2023.PMID 37096582
20. [20]Magi-Galluzzi C, Montironi R, Epstein JI Contemporary Gleason grading and novel Grade Groups in clinical practice. Current opinion in urology, 2016.PMID 27308734
21. [21]García-Fuentes C, Hernández V, Jiménez-Alcaide E et al. Active Surveillance as Preferred Treatment for ISUP Grade I Prostate Cancer: Confronting the ProtecT Trial. Archivos espanoles de urologia, 2024.PMID 39632514
22. [22]Yang YJ, Yang EJ, Nguyen TT et al. Transperineal Versus Transrectal Prostate Biopsy: A Systematic Review and Meta-analysis of Randomized Controlled Trials Across Settings With and Without Magnetic Resonance Imaging Targeting. European urology open science, 2026.PMID 41551330