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Prostate screening (PSA)

Latvia and Lithuania fund PSA testing for men in their fifties and sixties. Sweden assessed the same evidence and recommends against an organised programme. Here is what the trials actually found.

Šiame puslapyje aprašomos patikros programos; tai nėra diagnozė, nėra asmeninis rizikos įvertinimas ir nepakeičia jūsų sveikatos priežiūros paslaugų. Amžiaus grupes nustato kiekviena valstybė ir jos kinta — gautas kvietimas ir jūsų šalies puslapyje nurodyta institucija yra svarbesni už viską, kas parašyta čia. Patikra skirta žmonėms be simptomų: naujas gumbas, matomas kraujas, pasikeitęs apgamas, nepaaiškinamas svorio mažėjimas ar staigus regos arba klausos pokytis reikalauja gydytojo dabar, kad ir ką rodė neseni patikros rezultatai.

Kur tai organizuojama ir kokio amžiaus

Kiekviena šio regiono šalis, kuri tai vykdo kaip organizuotą programą, su savo amžiaus grupe. Grupės skiriasi todėl, kad nacionalinės institucijos tuos pačius įrodymus vertina skirtingai, o ne todėl, kad kuri nors iš jų klystų.

What PSA measures, and what it does not

Prostate-specific antigen is a protein made by the prostate, and its level in blood rises with prostate cancer. It also rises with benign enlargement, with prostatitis, after a urinary infection, after a long bicycle ride and after ejaculation. It is a prostate test, not a cancer test. That is the root of every difficulty in this section: a raised PSA sends men down a diagnostic pathway most of whom did not need, while a normal PSA does not guarantee the absence of cancer.

The trial evidence, without the spin

The European randomised study of screening for prostate cancer is the largest trial, and at thirteen years of follow-up it found one prostate cancer death averted for every 781 men invited to screening, and for every 27 extra cancers detected. The Cochrane review of the randomised trials concluded that screening did not significantly reduce prostate-cancer-specific mortality overall. Both statements are true; they weigh the same data differently. What is not in dispute is the denominator: many men are diagnosed and treated so that a few avoid dying.

Why overdiagnosis matters more here than anywhere else

Prostate cancer is common, often slow, and frequently never becomes a problem in a man’s lifetime. Screening finds those indolent cancers efficiently, and until recently a diagnosis usually meant surgery or radiotherapy, with rates of incontinence and erectile dysfunction that are not trivial. This is the strongest example in medicine of a screening test whose harms are concrete and whose benefits are statistical. It is why Sweden’s national body assessed PSA screening for men aged 50 to 70 and recommended against offering it.

What has changed: MRI first, and active surveillance

The picture is genuinely improving. Doing an MRI before deciding on a biopsy lets many men with a raised PSA avoid biopsy altogether and helps find the cancers that matter. And active surveillance — monitoring a low-risk cancer with repeat tests rather than treating it — is now standard practice, which decouples "diagnosed" from "treated" for a large share of screen-detected disease. Research programmes across Europe are testing whether a risk-stratified pathway built this way can shift the balance enough to justify organised screening, and the 2022 European recommendation asks countries to pilot exactly that rather than to roll it out.

If you are deciding

This is a decision to make with a doctor, not from a table. What should feed into it: your age, your family history — a father or brother with prostate cancer raises risk substantially, and several countries lower the funded starting age to 45 on that basis — your ethnic background, other health conditions that shape how much a slow cancer would matter, and how you personally feel about the trade between knowing and not knowing. Urinary symptoms, incidentally, are usually benign enlargement rather than cancer, but they are a reason to see a doctor rather than a reason to order a test online.

Šaltiniai:ERSPC, prostate cancer mortality at 13 years of follow-up, The Lancet 2014 · Cochrane Database of Systematic Reviews — Screening for prostate cancer (Ilic and colleagues) · Socialstyrelsen — prostate cancer screening: recommendation not to offer · SPKC — prostate cancer preventive check, men 50–75 every two years· patikrinta2026-09-07

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