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.