PSA test after 50: what a British study of 415,357 men found after 15 years

General information, not medical advice. Whether a PSA test makes sense for you is something you decide together with your GP.

Are you 50 or older? You may hear that it is a good idea to have your PSA checked. Yet in Belgium a PSA test after 50 is not a standard check-up. The test finds prostate cancer, but also many cancers that would never have bothered you.

What does a PSA test after 50 measure?

PSA stands for prostate-specific antigen, a substance in the blood made by the cells of the prostate. The prostate is a gland below the bladder that produces seminal fluid. With prostate cancer, the PSA level usually rises. According to the patient guideline on prostate cancer from Gezondheid en Wetenschap, the Flemish health website of the Belgian Centre for Evidence-Based Medicine (Cebam), a raised level often has another cause, such as inflammation or a benign enlargement of the prostate.

The same guideline writes that the tumour usually grows very slowly and that you often never get symptoms. More men die with prostate cancer than from prostate cancer. The disease almost always develops after the age of 60, and your risk is 2 to 3 times higher if your father or brother was diagnosed with prostate cancer. More than 90% of men with prostate cancer that has not spread survive longer than 10 years.

What a large British study found

The CAP study followed men aged 50 to 69 from 573 GP practices in England and Wales. It is a randomised trial: a draw decided which practices invited their men once for a PSA test and which did not. In total, 415,357 men were eligible, with an average age of 59.

After 10 years, 3 in 1,000 men had died of prostate cancer in both groups, Gezondheid en Wetenschap reported in 2018. Only with longer follow-up did a small difference emerge. In 2024 the medical journal JAMA published the analysis after about 15 years: 0.69% of men in the invited group died of prostate cancer, against 0.78% in the control group. From all causes combined, 23.2% died against 23.3%, and that difference was not statistically clear. The researchers themselves call the drop in absolute numbers small.

The test mainly brought more small, low-grade tumours to light: 2.2% against 1.6%. Among the invited men, 8 deaths were related to a biopsy or treatment, against 7 in the control group. A biopsy means removing a small piece of prostate tissue to examine under a microscope.

Why Belgium does not run a screening programme

According to Gezondheid en Wetenschap, systematic screening could lower deaths from prostate cancer somewhat. The big problem is overtreatment: many men have a dormant cancer that never causes problems, but a diagnosed cancer almost always leads to major treatment. That can cause involuntary urine leakage and erectile problems. That is why screening is neither recommended nor organised in Belgium.

In November 2025, two urologists argued on the Flemish news site Knack.be for population screening for men from the age of 50. According to Gezondheid en Wetenschap, the test is not accurate and can hardly predict whether a cancer will spread. More than half of treated men face unwanted complications. Despite better imaging, such as MRI, overdiagnosis and overtreatment remain a big problem.

A PSA test after 50 is a choice you weigh carefully

According to Gezondheid en Wetenschap, the guidelines of international urology associations state that a PSA test can be offered to men aged 50 to 69, after thorough information about the pros and cons and the risks of treatment. The Belgian Health Care Knowledge Centre (KCE), which advises the Belgian government on health care, made a decision aid in 2014 for use during a consultation. According to the KCE, a man who asks for screening should be informed as fully as possible about the benefits, the uncertainties and the drawbacks. With a stool test after 50 the question of what screening achieves also comes up, although that is an organised screening programme. For a broader look at healthy ageing, read about the five levers for more healthy years or how to measure your blood pressure at home.

When to see a doctor

Are you over 50 and do you need to pee often, have a weak or interrupted stream or feel that your bladder does not empty completely? According to Gezondheid en Wetenschap, a prostate condition may be involved. With prostate cancer that has spread, bone pain is the most common symptom, especially in the ribs and spine. If you want a PSA test anyway without symptoms, Gezondheid en Wetenschap says you can arrange it through your GP, after a thorough discussion of the pros and cons.

Sources

• Gezondheid en Wetenschap (Cebam). Prostaatkanker. Patient guideline, last updated on 30 April 2026 (in Dutch).
• Finoulst M. Bevolkingsonderzoek prostaatkankerscreening voorlopig niet aan de orde. Gezondheid en Wetenschap (Cebam), 6 November 2025 (news analysis, in Dutch).
• Cebam. Biedt de test op prostaatkanker geen betere levensverwachting? Gezondheid en Wetenschap, 9 March 2018 (review of the CAP study after 10 years, in Dutch).
• Martin RM e.a. Prostate-Specific Antigen Screening and 15-Year Prostate Cancer Mortality: A Secondary Analysis of the CAP Randomized Clinical Trial. JAMA, 2024 (randomised trial, secondary analysis).
• Mambourg F e.a. Een beslishulp bij de vraag naar prostaatkankeropsporing met de PSA test, Synthese. KCE Report 224As, Belgian Health Care Knowledge Centre, 2014 (decision aid based on a literature review, Dutch version).