Cochrane Systematic Review Finds PSA Screening Saves Lives

On 15 May 2026, Cochrane, considered the gold standard of evidence-based medicine, concluded for the first time that PSA-based prostate cancer screening likely reduces prostate cancer mortality.

The updated systematic review analysed data from nearly 789,000 men across six randomised controlled trials and found that PSA testing likely reduces prostate cancer deaths, with approximately 2 fewer deaths per 1,000 men screened over 23 years of follow-up, and may also reduce all-cause mortality. Critically, the review found no evidence of increased serious harms from biopsy or treatment. This reverses two previous Cochrane conclusions from 2006 and 2013 that found no mortality benefit, and was driven in large part by new long-term data from two additional trials encompassing over 250,000 participants.

The review also confirmed that PSA screening increases detection of localised cancer and may reduce metastatic diagnoses, which resonate strongly with the goal of early detection leading to better outcomes. The review also noted that newer screening approaches combining PSA with kallikrein panels and MRI may have potential, though mortality data are still pending.

For Australian urologists, this global evidence shift arrives at a pivotal moment. The Early Detection of Prostate Cancer guidelines led by the Prostate Cancer Foundation of Australia (PCFA) is still under review by NHMRC and the acceptance of these Guidelines is now eagerly awaited. This reversal by Cochrane is likely to inform both their recommendations and the ongoing national conversations of PSA screening.

USANZ members are encouraged to engage with these evolving guidelines and continue advocating for informed, patient-centred discussions around prostate cancer early detection.

Read the Cochrane Media Release.

Read an article about this decision in Nature.