A large-scale health economics study from Hong Kong (HK) is placing prostate cancer screening back in the policy spotlight, offering one of the strongest data-driven cases so far for the selective use of prostate‑specific antigen (PSA) testing in middle‑aged and older men.

Drawing on advanced modelling techniques and regional clinical data, the research suggests that PSA screening, when applied in a targeted and risk‑stratified way, can drastically cut both the rate of late-stage diagnosis and deaths from prostate cancer, while remaining well within internationally accepted limits of cost‑effectiveness.

The work was led by researchers from the University of Hong Kong’s LKS Faculty of Medicine and published in the peer‑reviewed journal The Lancet Regional Health – Western Pacific. It addresses a long‑standing dilemma faced by many health systems.

Prostate cancer often develops silently. Symptoms typically appear late, when treatment options are fewer, more invasive, and far more expensive. Yet some countries have hesitated to introduce widespread screening programmes, concerned about overdiagnosis, overtreatment, and costs.

In Hong Kong, that tension has become increasingly visible. Prostate cancer now ranks as the city’s third most common cancer among men, according to official Health Bureau figures. The same figure applies to Malaysia.

Incidence continues to climb, driven largely by population ageing and longer life expectancy. Despite this, there is still no organised, territory‑wide screening programme for prostate cancer, unlike for breast or colorectal cancer.

The new study was designed to test whether this cautious stance still makes sense in light of modern evidence, better treatment pathways, and more refined screening methods.

Using a population‑based microsimulation model, the researchers evaluated 56 different PSA screening strategies. These ranged from no screening at all to annual testing across various age groups. One of the most striking findings emerged from a strategy involving annual PSA tests for men aged between 45 and 75.

Under this approach, the proportion of men diagnosed with advanced‑stage prostate cancer at their first clinical assessment dropped from roughly 39 percent to around 1 percent. That change alone represents a profound shift in how the disease would present at a population level. Earlier detection often means less aggressive treatment, improved quality of life, and better long‑term outcomes.

Mortality data followed a similar pattern. The model estimated that annual prostate cancer deaths could fall from 6.14 percent to 2.85 percent in the screened population. While these percentages may seem abstract, in real terms they translate into hundreds of lives saved over time in a city the size of Hong Kong.

The implications are not limited to survival alone. Advanced prostate cancer often requires complex therapy. Hormonal treatment, chemotherapy, prolonged hospital care, and palliative services all place a heavy burden on patients, families, and the public healthcare system. Preventing progression to this stage changes the economic equation as much as the clinical one.

Cost was therefore a central focus of the analysis. The research team compared the projected cost of city‑wide screening and follow‑up treatment against the economic value of the health benefits gained. Their benchmark was the cost‑effectiveness threshold commonly referenced by the World Health Organization, which considers an intervention to be good value if the cost per quality‑adjusted life year gained is below a country’s gross domestic product per capita.

For Hong Kong, with a GDP per capita of approximately US$55,000, the numbers were clear. The estimated incremental annual cost per screened individual was around US$4,950. This figure sits far below the threshold, placing PSA screening firmly in the category of “highly cost‑effective”.

In simple terms, the researchers concluded that the health gains generated by screening greatly outweigh the financial investment required. In fact, the study argues that the case for screening becomes stronger in a high‑income city like Hong Kong, where medical infrastructure is robust and treatment costs for late‑stage cancer are particularly high.

The findings also address a frequent criticism of PSA testing: the risk of overdiagnosis. PSA levels can rise for reasons unrelated to cancer, and some prostate tumours grow so slowly that they may never cause harm during a man’s lifetime. Detecting these cases can lead to unnecessary biopsies or treatment, with physical and psychological side effects.

To tackle this concern, the study explored the concept of “precision screening”. Rather than applying the same screening interval and starting age to all men, this approach tailors screening intensity according to individual risk.

A key tool in this strategy is the use of polygenic risk scores. These scores combine information from multiple genetic markers associated with prostate cancer to estimate a man’s inherited risk of developing the disease. By integrating genetic risk with age and clinical factors, screening can be focused where it is most likely to deliver benefit.

Under this model, men classified as high risk would begin screening earlier and undergo testing more frequently. Those in low to medium risk categories, representing roughly two‑thirds of the population, could start later or be screened less often. The simulations showed that this stratified approach preserves most of the survival benefits of annual screening while reducing unnecessary tests and procedures.

From a system perspective, this matters. Public healthcare services in Hong Kong already face pressure from chronic disease management, an ageing population, and rising expectations. Precision screening, the researchers argue, offers a way to maximise health gains without overwhelming existing services.

The study also stands out for its regional relevance. While focused on Hong Kong, the model incorporated clinical and epidemiological data from both Hong Kong and mainland China. This broader evidence base strengthens the credibility of the conclusions and suggests that similar middle‑ to high‑income populations across the Western Pacific region may draw comparable benefits, including Malaysia.

The research contributes to an evolving international conversation about prostate cancer screening. Large trials in Europe and the United States have already shown that PSA screening can reduce prostate cancer mortality, but debates about harm, cost, and feasibility have slowed policy adoption in many places.

What differentiates this analysis is its emphasis on modern screening design. It does not promote indiscriminate testing. Instead, it advocates for smarter, data‑guided screening that reflects advances in genetics, epidemiology, and health economics.

The timing may be critical. As male life expectancy increases, more men are living long enough for prostate cancer to develop and progress. Without early detection, health systems are likely to see rising numbers of advanced cases, each costly to treat and deeply disruptive to families.

By contrast, early‑stage prostate cancer is often manageable with active surveillance or minimally invasive treatment. Many patients maintain normal lives for years, sometimes decades, after diagnosis. From both a human and financial perspective, the difference is profound.

The study’s authors stress that screening should be accompanied by clear clinical pathways, shared decision‑making, and careful follow‑up. PSA testing alone is not a diagnosis. It is a starting point for further evaluation, including imaging and, where appropriate, biopsy.

For policymakers, the message is pragmatic rather than ideological. The question is no longer whether PSA screening can save lives. The evidence now strongly suggests that it can. The remaining challenge lies in how to implement it wisely, equitably, and sustainably.

Health authorities in Hong Kong have so far taken a cautious approach, citing the lack of local evidence. With this study, that gap has narrowed considerably. It provides locally relevant data, grounded in international standards, and aligned with contemporary thinking on personalised medicine.

Beyond Hong Kong, the findings may resonate across Asia‑Pacific health systems grappling with similar demographic trends. Prostate cancer may not attract the same public attention as some other cancers, but its impact is growing quietly, year by year.

As the debate continues, this research adds weight to the argument that early detection, guided by risk and supported by sound economics, can shift the trajectory of prostate cancer at a population level.

It also underscores a broader lesson for public health: prevention and early intervention, when done thoughtfully, often deliver the greatest returns, both in lives saved and resources preserved.