[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-354209-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-354209-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","screening-for-prostate-cancer-article-bestwick-and-wald","Screening for prostate cancer - Article - Bestwick and Wald","","Prostate cancer is the most commonly diagnosed cancer in UK men (excluding non-melanoma skin cancer), with more than 64,000 new cases and 12,000 deaths each year. The incidence–mortality gap drives concerns about over-diagnosis and whether population PSA screening offers net benefit. The UK National Screening Committee advised against PSA screening, citing uncertainty about benefits and harms. Risk-based PSA algorithms using PSA multiples of the median and age-specific risk show strong detection performance, and the ERSPC trial reports a mortality reduction with PSA screening. Adding pre-biopsy multiparametric MRI can reduce unnecessary biopsies and over-diagnosis, preventing estimated deaths while limiting overtreatment.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/screening-for-prostate-cancer-article-bestwick-and-wald/354209/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/screening-for-prostate-cancer-article-bestwick-and-wald/354209.png","ImageObject",300,407,{"name":42,"@type":43},"Pentious","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-23","2026-09-22",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why is prostate cancer screening controversial in the UK?","Question",{"text":63,"@type":64},"Screening is debated because incidence is much higher than mortality, raising concerns about over-diagnosis and uncertain net benefit versus potential harms.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What does the UK National Screening Committee recommend for PSA-based screening?",{"text":68,"@type":64},"It advises against population PSA screening and instead proposes PSA testing only for men with confirmed BRCA1 or BRCA2 variants, at 2-year intervals from ages 45 to 61.",{"name":70,"@type":61,"acceptedAnswer":71},"How do risk-based PSA algorithms and multiparametric MRI improve screening outcomes?",{"text":72,"@type":64},"Risk-based PSA testing converts PSA to multiples of the median and combines it with age-specific risk to improve detection. Adding pre-biopsy multiparametric MRI reduces unnecessary biopsies and over-diagnosis while maintaining detection of clinically significant disease.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},354209,1790165751,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":33,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":124},1374404730887,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Screening for prostate cancer  \nJonathan P Bestwick 1  and Nicholas J Wald2   \nJ Med Screen 2026, Vol. 33(2) 67–70 © The Author(s) 2026  \nArticle reuse guidelines:  \n[sagepub.com/journals-permissions](sagepub.com/journals-permissions)[ ](sagepub.com/journals-permissions)[DOI: 10.1177/09691413261440207](DOI: 10.1177/09691413261440207)[ ](DOI: 10.1177/09691413261440207)[journals.sagepub.com/home/msc](journals.sagepub.com/home/msc)  \nAbstract  \nProstate cancer is the most commonly diagnosed cancer in UK men excluding non-melanoma skin cancer, with over 64,000 new cases and 12,000 deaths annually. This disparity between incidence and mortality has fuelled debate about over-diagnosis and the value of screening. The UK National Screening Committee has advised against population prostate-specific antigen (PSA) screening, citing uncertainty regarding benefit and harm. However, a risk-based PSA screening algorithm that adjusts PSA levels to multiples of the median for the same age and incorporates age-specific risk demonstrated good screening performance (detection rate of 90% for a false-positive rate of 2%). The European Randomized Study of Screening for Prostate Cancer shows a 16% reduction in prostate cancer mortality with PSA screening, comparable to reductions achieved in bowel cancer screening. The addition of pre-biopsy multi-parametric magnetic resonance imaging (MRI) screening reduces unnecessary biopsies and over-diagnosis while maintaining detection of clinically significant disease. Together, risk-based PSA testing combined with multi-parametric MRI would prevent an estimated 13 prostate cancer deaths per 1000 men screened every 5 years from age 55, with 9 deaths prevented for every man treated unnecessarily.  \nKeywords  \nProstate cancer screening, PSA, prostate-specific antigen Received: 23 March 2026; accepted: 23 March 2026  \nFrom age 50, the risk of a diagnosis of clinically significant prostate cancer in men is 9 .5% .1 In the UK, prostate cancer is now the most commonly diagnosed cancer excluding non-melanoma skin cancer. In 2022, the most recent year UK data are available, there were just over 64,000 new prostate cancer diagnoses in the UK2–5 and just over 12,000 deaths6–8 (Table 1), both accounting for about 15% of cancer diagnoses and cancer deaths in men.  \nThe five-fold difference between prostate cancer diagnoses and deaths from prostate cancer poses a dilemma that has not been resolved. Is the difference due to the fact that most diagnosed cases are relatively indolent or does it reflect the result of effective treatment following a positive diagnosis, or both? This dilemma is illustrated by prominent public figures being diagnosed with prostate cancer assuming that early diagnosis has saved their life while experts, notably those advising those on the UK National Screening Committee, concluded in their advisory report in November 2025 that there is uncertainty over the efficacy of prostate cancer screening, stating that such screening ‘is likely to cause more harm than good’;9 the apparent good prognosis is simply a reflection of most diagnosed cases being indolent.  \nThe National Screening Committee, seeking to find a middle path, recommended that prostate cancer screening based on prostate-specific antigen (PSA) measurement should be limited to men with a confirmed BRCA1 or BRCA2 variant, and among such men PSA measurement performed every 2 years, from age 45 to 61. This effectively regards such variant analyses as a first-line screening test leading to PSA-based screening, although the National Screening Committee did not state a recommendation for population screening for these variants – not a satisfactory compromise. BRCA1 and BRCA2 variants are rare, present in about 1 in 250 of the general population.10 This means that as a first-line screening test, even if the BRCA status  \n1 Clinical Haematology, Royal London Hospital, Barts Health NHS Trust, London, UK  \n2UCL Institute of Health Informatics, University College Lo","cbCaii7g8OdruxfX","https://ap.wps.com/l/cbCaii7g8OdruxfX","pdf",479115,"English","# Abstract\n## Epidemiology and screening debate\n## UK National Screening Committee guidance\n## Risk-based PSA testing performance\n## Evidence from ERSPC trial\n## Role of multiparametric MRI in reducing harm","[{\"question\":\"Why is prostate cancer screening controversial in the UK?\",\"answer\":\"Screening is debated because incidence is much higher than mortality, raising concerns about over-diagnosis and uncertain net benefit versus potential harms.\"},{\"question\":\"What does the UK National Screening Committee recommend for PSA-based screening?\",\"answer\":\"It advises against population PSA screening and instead proposes PSA testing only for men with confirmed BRCA1 or BRCA2 variants, at 2-year intervals from ages 45 to 61.\"},{\"question\":\"How do risk-based PSA algorithms and multiparametric MRI improve screening outcomes?\",\"answer\":\"Risk-based PSA testing converts PSA to multiples of the median and combines it with age-specific risk to improve detection. Adding pre-biopsy multiparametric MRI reduces unnecessary biopsies and over-diagnosis while maintaining detection of clinically significant disease.\"}]","Screening for prostate cancer - Article - Bestwick and Wald | PDF",1790109491]