Swedish PSA screening program reaches 1 in 5 men, detects cancer in less than 1%
A five-year population-wide prostate cancer screening initiative in Sweden found that when men receive direct invitations to get tested, about 20% respond—but the actual cancer detection rate remains below 1%. The results highlight the tension between engagement and clinical benefit that health systems must navigate when expanding screening programs.
Originaltitel: The 5‐year outcomes of a regional population‐based <scp>PSA</scp> information and testing programme
OBJECTIVES: To report descriptive outcomes including prostate-specific antigen (PSA) testing, diagnostic activity and diagnostic outcomes during the initial 5 years of a regional mailed PSA information and testing programme. SUBJECTS AND METHODS: Between 2015 and 2019 a letter regarding the pros and cons of PSA testing was sent to all men in the Värmland region of Sweden in every fifth year age group between 50 and 70 years. A total of 44 530 men were informed and instructed to contact their primary care centre if they wished to have a PSA test. Men with a PSA level ≥3 μg/L were referred to a urologist for evaluation. We used local and national registers to report trends in PSA testing, diagnostic activity, and diagnostic outcomes after programme implementation. RESULTS: An average of 20% of informed men had a PSA test within 6 months, with increasing proportions over time. Among informed men, 3.5% had a PSA level ≥3 μg/L, 3.6% had a urology consultation, 1.5% underwent biopsies, and 0.8% were diagnosed with prostate cancer. [Correction added on 26 February 2026, after first online publication: The word 'tested' has been corrected to 'informed' in the preceding sentence.] The proportion who underwent magnetic resonance imaging was low. Between 2014 and 2017, the yearly number of PSA-tested men in the region increased from 4800 to 11 800 and the number of men undergoing prostate biopsies increased from 772 to 1217. Yearly prostate cancer incidence in the age group 50-74 years increased from 386 (2010-2013) to 659 cases/100 000 (2016-2019). We observed an increase mainly among intermediate- and low-risk tumours. At the end of the period, 80% of men in the older-age groups had had a PSA test during the preceding years. CONCLUSIONS: Organising a population-based mailed PSA information programme combined with accessible testing in primary care is feasible on a regional scale in a Scandinavian healthcare setting and may reach high attendance. An observed increase in low-risk tumours inspires caution against programme implementation and highlights the importance of well-designed screening strategies and diagnostic algorithms to avoid over-detection.