Prostate cancer is becoming an increasingly serious health problem for men, especially as populations age. In Hong Kong, it is now the third most common cancer among men.
Many cases are discovered too late, when the disease has already spread and treatment options are limited.
A new study from the University of Hong Kong offers strong evidence that this does not have to be the case.
Researchers from the Department of Surgery and the Department of Medicine at HKUMed have shown that a simple blood test, known as prostate-specific antigen or PSA screening, could greatly reduce both advanced prostate cancer and deaths from the disease.
Their findings suggest that starting PSA screening for men aged 45 and older could lower the rate of advanced-stage prostate cancer from about 39 percent to around 1 percent. At the same time, deaths from prostate cancer could fall from more than 6 percent to less than 3 percent. The study was published in The Lancet Regional Health—Western Pacific.
Prostate cancer often develops slowly and quietly. In its early stages, it may cause few or no symptoms. Many men do not feel pain or notice changes until the cancer has already grown or spread. By then, treatment becomes more difficult, more expensive, and less effective. This is one reason why prostate cancer outcomes can be poor when the disease is found late.
PSA screening works by measuring the level of a protein called prostate-specific antigen in the blood. Higher levels can be an early warning sign of prostate cancer, including more aggressive forms that are likely to spread.
The test itself is simple and widely available. However, Hong Kong currently does not have a targeted screening program for prostate cancer, partly because of concerns about cost and overdiagnosis.
To better understand whether screening is worthwhile, the research team carefully examined 56 different screening strategies. These included different starting ages, stopping ages, and testing frequencies.
One of the most effective approaches was annual PSA testing for men between the ages of 45 and 75. Under this strategy, the number of men first diagnosed with advanced cancer dropped sharply, and survival outcomes improved significantly.
Beyond health benefits, the researchers also studied whether such a screening program would make economic sense. Health care systems must balance benefits with costs, especially in a public system. The team found that even when accounting for screening costs and follow-up treatments, the program would be highly cost-effective.
They estimated that the added yearly cost per person would be around US$4,950. When compared to Hong Kong’s GDP per person, which is about US$55,000, this cost is relatively small.
According to standards set by the World Health Organization, the benefits far outweigh the costs. In other words, PSA screening offers good value for money, especially in a wealthy city like Hong Kong with strong medical resources.
The researchers also addressed a common concern about cancer screening: overdiagnosis. This happens when slow-growing cancers are found that may never cause harm, leading to unnecessary treatment and stress. To reduce this risk, the team proposed a more personalized approach known as risk-based or precision screening.
This approach uses genetic information, called polygenic risk scores, to estimate a man’s individual risk of developing prostate cancer. Men at higher risk could begin screening earlier and be monitored more closely.
Those at lower risk could start later or be tested less often. Because about two-thirds of men fall into the low-to-medium risk category, this strategy could greatly reduce unnecessary tests while still protecting those most at risk.
By adjusting screening to match individual risk, health resources could be used more efficiently without reducing survival rates. This also helps prevent overloading the health care system while still achieving early detection.
When reviewing the study’s findings, the evidence strongly supports introducing risk-based PSA screening in Hong Kong. The reduction in advanced cancer cases is striking, and the drop in death rates is meaningful. The economic analysis adds further strength, showing that the approach is not only medically effective but also financially sensible.
However, it is important to note that screening programs must be carefully designed and supported by clear guidelines, proper follow-up care, and public education. PSA screening should not be seen as a single solution, but as part of a broader cancer prevention strategy.
Overall, this study provides convincing data that early, targeted PSA screening could save lives, reduce suffering, and lower long-term health care costs. It offers a strong foundation for policymakers to reconsider prostate cancer screening guidelines and move toward earlier detection and better outcomes for men.
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