Rotterdam, 30 October 2025 – A prostate cancer screening program can reduce prostate cancer mortality, even in the long term. That is the take-away from research conducted by the European Randomized study of Screening for Prostate Cancer (ERSPC) in a large European group of screened men. ‘The longer the follow-up, the more reliable the results.’

Prostate cancer screening reduces mortality from this disease, according to analyses by ERSPC researchers in 2009. The same group of scientists has now proven that this conclusion still holds true, even more than twenty years after the start of their research. They report their findings in the New England Journal of Medicine. This is the third time that the researchers have published their results in this authoritative journal.

European cohort

The European researchers, led by Monique Roobol of the Erasmus MC Cancer Institute, analyzed the latest data from the European Randomized Study of Screening for Prostate Cancer (ERSPC). This is a group, originally consisting of more than 160,000 men from eight European countries, including 42,000 from Rotterdam, in the age of 55 to 69 years.

From the start of the study in 1993 until about ten years ago, half of these men underwent prostate screening every four years. This consisted of a PSA measurement (prostate-specific antigen) level in the blood. The higher the level, the greater the risk of prostate cancer. The other group was not screened. The researchers then counted the number of men in both groups who died from the effects of prostate cancer.

Reduced mortality

In 2009, the authors already showed that prostate cancer screening reduced the number of deaths by a fifth, and were able to confirm that conclusion in 2012. In 2025, it is still clear that prostate cancer screening reduces mortality from prostate cancer, says Roobol, international coordinator of the ERSPC study and professor of Decision making in Urology. ‘The beauty of this study is the long follow-up. That is exactly what is needed to see the effect of prostate cancer population-based screening. The effect increases over time.’

Prostate cancer is one of the leading causes of death among men in Europe: number one in Sweden, number two in Germany, and number five in many other countries. In the United Kingdom, more men die from prostate cancer each year than women die from breast cancer. With the aging population, the number of prostate cancer cases continues to rise. Nonetheless, prostate cancer screening is only available in a handful of European countries or regions, including Lithuania and parts of Sweden. Most other countries, such as the Netherlands, do not yet systematically screen for prostate cancer for fear of overdiagnosis and overtreatment.

Overdiagnosis

Indeed, many additional diagnoses were made in the ERSPC population, says Roobol: on average, 1,000 screenings resulted in 27 additional diagnoses of prostate cancer as compared to a clinical situation. ‘At least half of these were cancers that would most likely not have caused any symptoms. Thanks to screening, fewer men are dying of prostate cancer. But in the process, we are diagnosing and treating some of them unnecessarily.’

Roobol explains that this number of overdiagnoses is mainly due to the period in which the study was started. ‘The screening methods are more than 20 years old. New, better methods have since been developed. In addition, we now divide men who have decided to participate into subgroups. We used to test every man every four years. We have since learned that men with low PSA levels do not need to come back as often, because the chance of them developing prostate cancer is small.’

Follow-up

This analysis of the ERSPC study was the last in a European context. This is due to changes in privacy legislation in each country, explains Roobol. ‘It is no longer practically possible to bring all data together at an individual level. That is why we decided to publish one more time. From now on, research groups from participating countries will continue to publish separately.’

Roobol and her colleagues from the Urology Department will continue to follow the Rotterdam men in the coming years. ‘To date, just over half of the men have died, so in principle we can continue for a long time’, she says. ‘The longer the follow-up, the better the results can be mapped out.’

This article was published earlier at: Screening reduces prostate cancer mortality, even after more than twenty years – Amazing Erasmus MC.

Brussels/Arnhem, 25 April 2023 – The EU4Health programme has approved PRAISE-U (PRostate cancer Awareness and Initiative for Screening in the European Union), an ambitious three-year project involving 25 institutions from 12 countries. PRAISE-U’s mission is to design a nationally-tailored cost-effective early detection algorithm for prostate cancer screening in the EU to reduce morbidity and mortality caused by prostate cancer while avoiding overdiagnosis and overtreatment.

Prostate cancer is the number 1 and 2 cancer killing men in northern and western Europe respectively. It is the most frequent male cancer in Europe with important consequences for healthcare systems. Every year, around 450,000 European men are diagnosed with prostate cancer. Delayed diagnosis can lead to higher rates of metastasised disease, which is a disease state that coincides with a high mortality rate and a prolonged negative impact on the quality of life. It has been shown that organised repeated screening results in early detection that can reduce suffering and dying from prostate cancer.¹ Modern tools and strategies can streamline the process to detect cancer when it poses a threat to the patient.

In direct partnership with a network of consortium members, PRAISE-U works to encourage early detection and diagnosis of prostate cancer in EU Member States through smart early detection and stimulate the implementation of early detection programmes in Member States. By aligning protocols and guidelines across Member States and enabling the collection and analysis of relevant data, the project aims to reduce prostate cancer morbidity and mortality rates in Europe with customised and risk-based screening programmes.

Prof. Hein Van Poppel, chair of the EAU Policy Office: “The diagnostic pathway for prostate cancer has improved tremendously over the past decades². PRAISE-U marks a new era in early detection of prostate cancer. Through this project, we want to provide clear guidelines and quality assurance tools that can be used by pilot sites to demonstrate that risk based approaches are effective, feasible, acceptable and cost effective. In our consortium, we have a strong partnership with the right mix of international academic experts, healthcare professionals, social scientists, economists, patients and health system pilot sites to make this a success.”

To achieve PRAISE-U’s goals a multi-disciplinary consortium centred around Europe’s leading clinicians and researchers in prostate cancer has been established. The consortium includes experts in prostate cancer and decision making – amongst others the European Randomized study of Screening for Prostate Cancer -, and a network of hospitals, medical societies, patient advocates and national authorities.

The PRAISE-U project is broken down into six work packages. The four core WPs are designed to gather knowledge, develop protocols for screening programs, pilot test the developed protocols, and evaluate the results. The two overarching WPs provide a framework for the entire project and include coordinating the project and disseminating the results. Each WP builds on the work of the previous one, and together they contribute to the ultimate goal of developing a strategy that will reduce prostate cancer morbidity and mortality while minimizing overdiagnosis.

On 25-26th of April, more than 50 members of PRAISE-U participated in the kick-off event for a new Pan-European prostate cancer screening initiative in Brussels.

About PRAISE-U
PRAISE-U (PRostate cancer Awareness and Initiative for Screening in the European Union) is a multi-disciplinary consortium centred around Europe’s leading clinicians and researchers in prostate cancer that aims to reduce morbidity and mortality caused by prostate cancer through smart early detection by designing a cost-effective early detection algorithm for EU Prostate Cancer Screening. For more information check www.uroweb.org/praise-u.

Sources: 1. Hugosson, J., Roobol, M. J., Månsson, M., Tammela, T. L., Zappa, M., Nelen, V., … & Auvinen, A. (2019). A 16-yr Follow-up of the European Randomized study of Screening for Prostate Cancer. European urology, 76(1), 43-51. https://doi.org/10.1016/j.eururo.2019.02.009 2. Van Poppel, H., Albreht, T., Basu, P., Hogenhout, R., Collen, S., & Roobol, M. (2022). Serum PSA-based early detection of prostate cancer in Europe and globally: past, present and future. Nature reviews. Urology, 19(9), 562–572. https://doi.org/10.1038/s41585-022-00638-6.

Extended follow up needed to establish full impact of screening.

ROTTERDAM, The Netherlands (15 March 2012)

The long-running European Randomized Study of Screening for Prostate Cancer (ERSPC) today (15 March 2012) published its 11-year follow-up results. These add weight to their original findings by confirming that screening does significantly reduce death from prostate cancer. Appearing in the New England Journal of Medicine, the study finds that a man who undergoes PSA testing will have his risk of dying from prostate cancer reduced by 29%.

By extending the patient follow-up to an average of 11 years, the study shows that 31% fewer men than previously indicated would need to be diagnosed with cancer to save one life.

As Prof Fritz Schroeder, the international coordinator of the ERSPC study, explained: “Extending the follow up period strengthens the argument for screening. But it does not decide it. Even so, the risk reduction trend in our study is promising and it is imperative that we continue the follow-up. So far, only about 30% of all men in the study have died. If a larger reduction of prostate cancer mortality is seen by further extending the study beyond the current median of 11 years, we can determine with greater certainty whether the benefit of screening outweighs the disadvantages.”

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Stockholm, Sweden (18 March 2009)

Screening for prostate cancer can reduce deaths by 20%, according to the results of the European Randomized Study of Screening for Prostate Cancer (ERSPC) published online 1700 hours CET by the New England Journal of Medicine, Online First*. ERSPC is the world’s largest prostate cancer screening study and provides robust, independently- audited evidence, for the first time, of the effect of screening on prostate cancer mortality.

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