We read with interest the recent commentary by Derek Raghavan, MD, PhD, FACP, FASCO, FRACP, on ‘Prostate Screening Saved My Life’ Is That Really True in Most Cases?’ (The ASCO Post, April 25, 2026).1 As patient advocates, we agree with Dr. Raghavan on one important point: simplistic claims such as “PSA screening saved my life” should not be made casually.
PSA-based screening can lead to overdiagnosis, false positives, and treatment-related harms; those harms should be stated plainly. But this commentary goes too far when it implies that screening lacks meaningful clinical value and when it treats patient advocates as though we are merely repeating rhetoric fed to us by clinicians or industry. In our view, PSA testing is about information, not treatment. All too often, ill consequences arising from the PSA test are a result of poor communication between the clinician and the patient.
European Study of Prostate Cancer Screening
The strongest randomized evidence, the European Randomized Study of Prostate Cancer Screening (ERSPC) trial, shows a statistically significant reduction in prostate-cancer mortality with long follow-up: a 13% relative reduction and a 0.22% absolute reduction at 23 years.2 That is a modest benefit, and those of us who support screening should say so clearly. But modest is not the same as nonexistent. The ERSPC study also showed a 30% reduction in metastatic disease among those screened. That translates into a direct reduction in prostate cancer–specific mortality. Preventing metastatic presentation is a meaningful outcome to men and their families.
From a patient-advocate perspective, however, the real issue is broader than ERSPC alone. PSA can lead to two very different kinds of outcomes. For men with aggressive disease, earlier detection may lead to diagnosis before metastatic spread and a better chance of long-term control. The number of men with high-risk, very high-risk, and metastatic disease at diagnosis has been growing. Fifteen years ago, synchronous metastatic presentation was accepted to be around 4% to 5% of new cases. By 2023, Devasia et al estimated that number as high as 8%.3 Today that number may exceed 10% according to expert resources. In hard numbers that represents 30,000 men annually who present with de novo metastatic disease. Failing to use a PSA test widely consigns many to an early grave. Further, we disagree with Dr. Raghavan that prostate cancer can be cured if greater than grade group 1—durable and continuing remission is the optimal outcome.
PSA Pros and Cons
We also recognize the other side of this issue. For other men with low-risk disease, PSA testing may begin a cascade of labeling, anxiety, repeated testing, pressure toward active treatment, and life-changing side effects that may not be necessary. Organizations like AnCan Foundation (https://ancan.org) have programs in place to support those men as well as those men presenting with de novo metastatic disease.
As advocates, we have seen both pros and cons of screening. Some men are spared the devastation of presenting with high-risk, very high-risk, or metastatic disease. Others, including men on active surveillance, may be pushed toward active treatment and left with urinary, sexual, or bowel complications that permanently affect their quality of life. Even men with low-risk prostate cancer who remain on surveillance may still bear the burden of being labeled as patients with cancer, with all the fear and social consequences that can follow, including concerns about insurance discrimination.4
We reject the suggestion in Dr. Raghavan’s commentary that advocacy groups are influenced into these views as passive instruments of pharmaceutical companies or physicians. That characterization is patronizing. Many of us hold these beliefs because of direct lived experience with diagnosis, surveillance, treatment pressure, recurrence, metastatic disease, suffering, loss, and the consequences of both overtreatment and late detection. Sadly, screening is never likely to reduce the approximate 30% recurrence rate. Our science is not good enough to identify and remove all Gleason 4 (high-grade) prostate cancer at the time of diagnosis and initial treatment. However, it may prevent diagnosis at a later stage with high-risk or advanced disease.
The most balanced conclusion is neither “screen every man” nor “screen no man.” It is that PSA screening offers a small but statistically significant reduction in prostate-cancer mortality, appears to reduce metastatic presentation, and should be used in a selective, risk-adapted way that emphasizes shared decision-making and minimizes unnecessary treatment. But that discussion must also include the men with aggressive disease who are missed and the men with low-risk disease who are harmed by unnecessary intervention. A serious patient-centered view has to hold both truths at once.
—Rick Davis and Howard Wolinsky
DISCLOSURES: Mr. Davis is Founder, AnCan Foundation, Tubac, Arizona. Mr. Wolinsky is Publisher, The Active Surveillor, Flossmoor, Illinois.
REFERENCES
1. Raghavan D: ‘Prostate Screening Saved My Life’—Is That Really True in Most Cases? The ASCO Post. April 25, 2026. https://ascopost.com/issues/april-25-2026/prostate-screening-saved-my-life-is-that-really-true-in-most-cases/ Accessed May 21, 2026.
2. Roobol MJ, de Vos II, Mansson M, et al: European Study of Prostate Cancer Screening—23-year follow-up. N Engl J Med 393:1669-1680, 2025.
3. Devasia T, Mariotto AB, Nyame YA, et al: Estimating the number of men living with metastatic prostate cancer in the United States. Cancer Epidemiol Biomarkers Prev 32:659-665,
4. Eggener S, Berlin A, Vickers AC, et al: Low-grade prostate cancer: Time to stop calling it cancer. J Clin Oncol 40: 3110-3114, 2022.
