TOPLINE:

Overdiagnosis from prostate-specific antigen (PSA) screening rises sharply with age, reaching about one third of prostate cancers detected at age 70.

METHODOLOGY:

• US guidelines don’t recommend routine PSA screening in men aged 70 years or older, but screening still occurs opportunistically outside these guidelines, often triggered by erectile dysfunction, hematuria, and other issues generally unrelated to prostate cancer.
• To gauge the extent of overdiagnosis — the detection and treatment of silent prostate cancers that will not affect men in their lifetime — researchers determined the extra number of cancers found with PSA screening compared with usual care over a 15-year period in the UK CAP trial, which included more than 400,000 men.
• They then combined the trial’s estimates of how long prostate cancers take to present clinically with symptoms with age-specific mortality data to estimate the likelihood that a screen-detected prostate cancer would not become clinically apparent within 15 years because men died from other causes.

TAKEAWAY:

• Approximately 11.7% of screen-detected prostate cancers in UK CAP would not have been diagnosed within 15 years without screening, suggesting they would not have become symptomatic.
• Men diagnosed by screening at age 50 had a 16% chance that their tumors would not have presented clinically within 15 years; the chance rose to 20% at age 59, 24% at age 64, 32% at age 70, and 58% at age 80.

IN PRACTICE:

Policies that allow opportunistic PSA testing outside of guidelines have led to high rates of screening in older men and substantial overdiagnosis and “should be re-examined,” the investigators of the study wrote. Alternatives could reduce overdiagnosis by, for instance, “ending the availability of PSA testing through primary care for asymptomatic older men.”

SOURCE:

The study, led by Adam R. Brentnall, Wolfson Institute of Population Health, Queen Mary University of London, London, England, was published online on April 22, 2026, in the International Journal of Cancer.

LIMITATIONS:

Data were limited to the UK. The study didn’t address the benefits of treating early disease. Screening in UK CAP occurred from 2001 to 2007, before newer techniques to better distinguish low-grade disease and reduce overdiagnosis were available. Estimates were based on modeling rather than directly observed long-term outcomes.

DISCLOSURES:

The study was funded by the National Cancer Institute and Cancer Research UK. The investigators disclosed ties to Median Technologies, OPKO Diagnostics, Hologic, and GRAIL.