The European Randomised Study of Screening for Prostate Cancer (ERSPC) 
demonstrated a significant reduction in prostate cancer-specific mortality. The 
ongoing Comparison Arm for ProtecT (CAP) cluster randomised controlled trial 
(RCT) evaluates prostate cancer screening effectiveness by comparing primary 
care centres allocated to a round of prostate specific antigen (PSA) testing 
(intervention) or standard clinical care. Over 550 centres (around 450,000 men) 
were randomised in eight United Kingdom areas (2002-2008). Intervention group 
participants were also eligible for the ProtecT (Prostate testing for cancer and 
Treatment) RCT evaluating active monitoring, radiotherapy and radical 
prostatectomy treatments for localised prostate cancer. In ProtecT, over 1500 of 
around 3000 men with prostate cancer were randomised from over 10,000 with an 
elevated PSA in around 111,000 attendees at clinics. Investigation of the 
psychological impact of screening in a sub-sample showed that 10% of men still 
experienced high distress up to 3 months following prostate biopsies (22/227), 
although most were relatively unaffected. The risk of prostate cancer with a 
raised PSA was lower if urinary symptoms were present (frequent nocturia odds 
ratio (OR) 0.44, 95% confidence interval (CI) 0.22-0.83) or if a repeat PSA 
decreased by > or = 20% prior to biopsy (OR 0.43, 95% CI 0.35-0.52). Men aged 
45-49 years attended PSA clinics less frequently (442/1299, 34%) in a nested 
cohort with a cancer detection rate of 2.3% (10/442). The CAP and ProtecT trials 
(ISRCTN92187251 and ISRCTN20141217) will help resolve the prostate cancer 
screening debate, define the optimum treatment for localised disease and 
generate evidence to improve men's health.