We highly reccomend the accompanying editorial as a quick read. It argues the benefit of PSA screening is now without doubt. In fact, a 13% reduction in cancer mortality mirrors that seen with breast or colon cancer screening, neither of which have faced the free-for-all that has defined prostate cancer screening for decades. In fact, ERSPC certainly underestimates benefit by allowing initiation of screening at any age prior to 70: “Initiation of testing at 50 years of age has resulted in risk reductions that are more than double those among men who start testing at age 60, which is the median age of the first PSA screening test in the ERSPC.” Not to mention the vast improvement in the therapeutic index of our treatments–cough, namely dose-escalated focal radiation, cough, cough. ERSPC also overestimates harm considering in this era virtually all men with elevated PSA underwent biopsy and all confirmed cancers received definitive treatment regardless of disease risk or patient health. Ultimately it calls for unifying commonsense national guidelines in place of inconsistent patient-led PSA testing that screens too few men in their 50s and too many in their 70s. | Vickers, N Engl J Med 2025
