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Prostate Cancer

Does having PSA tests before anything is wrong actually change anything?

In Korean national data it changes what treatment you get. Men tested beforehand were far more likely to have surgery; men who were not were far more likely to be put on hormone therapy.

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Answer

Prior PSA testing is associated with a large difference in the treatment a man receives: among 166,848 Korean men newly registered with prostate cancer between 2010 and 2020, those with at least three PSA tests across at least two years beforehand received surgery in 45.6 percent of cases against 33.8 percent of those never tested, while hormone therapy was used in 42.3 percent of the tested group against 59.7 percent of the untested — and the untested group's higher cumulative spending came from being on systemic treatment for longer rather than from any treatment costing more per month.

Key takeaways

  • 166,848 Korean men newly registered with prostate cancer from 2010 to 2020 were analysed from national insurance data.
  • 26.7 percent had at least three PSA tests across at least two years before registration; 42.2 percent had none.
  • Surgery was the initial treatment for 45.6 percent of the tested group against 33.8 percent of the untested (p < 0.001).
  • Hormone therapy was used in 59.7 percent of the untested group against 42.3 percent of the tested (p < 0.001).
  • Chemotherapy was used in 2.7 percent of the untested group against 1.0 percent of the tested.
  • Per-patient costs of non-robotic surgery and radiotherapy were comparable between the groups.
  • The study measures treatment patterns and costs, not survival, so it does not show that PSA testing saves lives.

The argument about PSA screening is normally conducted in terms of whether it reduces deaths, where the evidence is genuinely contested and this study has nothing to add. It answers a narrower question that Korean national data can settle: among men who did get prostate cancer, what differed depending on whether anyone had been testing them.

45.6% vs 33.8%

share receiving surgery as first treatment — men with repeated PSA testing before diagnosis, against men with noneKo YH et al., Investigative and Clinical Urology, 2026

Localised treatment against systemic treatment

Every localised option was more common in the tested group — surgery, radiotherapy, focal therapy. Every systemic option was more common in the untested group: hormone therapy at 59.7 against 42.3 percent, chemotherapy at 2.7 against 1.0 percent, androgen receptor-targeted agents at 1.4 against 0.5 percent.

Localised treatment is what is offered when the cancer is confined to the prostate. Systemic treatment is what is offered when it is not. So the treatment split is effectively a stage distribution reported through the insurance system, and it says the untested men arrived with more advanced disease.

What it cannot tell you

Survival is not an endpoint here. And men who get tested repeatedly differ from men who never do in every way that health-seeking behaviour differs — income, education, urban residence, having a regular doctor. Any of those could produce this treatment split without PSA doing any of the work.

Read alongside the finding that roughly half of Korean prostate cancer is high risk at diagnosis, and that active surveillance eligibility has been falling, the picture is consistent: prostate cancer in Korea is being found late. Whether PSA testing is the right fix for that is a separate argument, and this study does not settle it.

Sources

  1. 1

    Ko YH, Kim SW, Son NH

    Impact of repeated prostate-specific antigen testing on management patterns and personal healthcare spending for prostate cancer: A population-based study National Health Insurance data for 166,848 patients in South Korea from 2010 to 2020

    Investigative and Clinical Urology 2026;67(3):263-272

    doi:10.4111/icu.20250537 · PMID:42065662

    https://doi.org/10.4111/icu.20250537