Five-year interval is safe for prostate cancer screening, research shows

 A PSA blood test every five years is sufficient to screen low-risk men for prostate cancer, new research has shown.

In Europe, only Lithuania routinely screens men for prostate cancer based on their PSA levels, as the test has historically been seen as insufficiently reliable. The German study, presented at the 2024 European Association of Urology (EAU) Annual Congress involved over 12,500 men aged between 45 and 50 years taking part in the ongoing PROBASE trial, which is testing different prostate cancer screening protocols. The research has also been accepted for publication in European Urology.

PROBASE is recruiting men aged 45 and splitting them into three groups based on their initial PSA test. Men with a PSA level of under 1.5 nanograms per millilitre (ng/ml) are deemed low risk and followed up with a second test after five years. Men with a PSA level between 1.5-3ng/ml are deemed intermediate risk and followed up in two years. Those with a PSA level over 3ng/ml are seen as high risk and given an MRI scan and biopsy.

Of over 20,000 men recruited to the trial and deemed low risk, 12,517 have now had their second PSA test at age 50. The researchers found that only 1.2 per cent of these (146 in total) had high levels of PSA (over 3ng/ml) and were referred for an MRI and biopsy. Only 16 of these men were subsequently found to have cancer – just 0.13 per cent of the total cohort.

The EAU recommends that men should be offered a risk-adapted strategy (based on initial PSA level), with follow-up intervals of two years for those initially at risk, in which they include men with PSA over 1ng/ml. The new findings suggest that the screening interval for those at low risk could be much longer with minimal additional risk.

Lead researcher, Prof Peter Albers, from the Department of Urology at Heinrich-Heine University Düsseldorf, Germany, explained: “By raising the bar for low risk from 1ng/ml to 1.5, we enabled 20 per cent more men within our cohort to have a longer gap between tests and very few contracted cancer in that time. With nearly 14 million men aged between 45 and 50 in Europe, the numbers affected by such a change would be significant. Our study is still underway and we may find that an even longer screening interval of seven, eight or even 10 years, is possible without additional risk.”

Current guidelines and policies from European governments and health bodies remain contradictory and unclear, leading to high levels of opportunistic testing and inequality of access to early diagnosis, according to further research presented at the EAU Congress.

The study reviewed early detection policies across the European Union and carried out focus groups with urologists to identify how guidelines were interpreted in clinical practice. Dr Katharina Beyer, from the Department of Urology at the Erasmus MC Cancer Institute in Rotterdam, Netherlands, carried out the research. She said: “Some country’s guidelines are actively against screening, others are non-committal and a few, such as Lithuania, have some form of screening. But in many countries, if you ask for a test, you can get one, sometimes free and sometimes not. This means that well-educated men, who know about PSA tests, are more likely to be screened and get an early diagnosis, while others with less knowledge are at a disadvantage.”