The rate of overdiagnosis of prostate cancer (defined as the diagnosis in men who would not have clinical symptoms during their lifetime) has been estimated to be as high as 50% in the screening group.30 Consistent estimates of overdiagnosis (a third of cancers detected on screening) have also been obtained by identifying potentially indolent prostate cancers on the basis of clinical and pathological characteristics.31-33 Overdiagnosis and overtreatment are probably the most important adverse effects of prostate-cancer screening and are vastly more common than in screening for breast, colorectal, or cervical cancer. 34
With PSA tests producing so many false positives, that induces worry in many men who don't necessarily need to, and the false negatives with DREs are definitely unwanted.
Has a more reliable test been developed for diagnostic screening for prostate cancer?
Jones, D., Friend, C., Dreher, A., Allgar, V., & Macleod, U. (2018). The diagnostic test accuracy of rectal examination for prostate cancer diagnosis in symptomatic patients: a systematic review. BMC family practice, 19(1), 1-6. https://doi.org/10.1186/s12875-018-0765-y
Schröder, F. H., Hugosson, J., Roobol, M. J., Tammela, T. L., Ciatto, S., Nelen, V., ... & Auvinen, A. (2009). Screening and prostate-cancer mortality in a randomized European study. New England journal of medicine, 360(13), 1320-1328. https://doi.org/10.1056/NEJMoa0810084
Stamey, T. A., Yang, N., Hay, A. R., McNeal, J. E., Freiha, F. S., & Redwine, E. (1987). Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. New England Journal of Medicine, 317(15), 909-916. https://doi.org/10.1056/NEJM198710083171501
Torp-Pedersen, S. T., Littrup, P. J., Lee, F., & Mettlin, C. (1988). Early prostate cancer: diagnostic costs of screening transrectal US and digital rectal examination. Radiology, 169(2), 351-354. https://doi.org/10.1148/radiology.169.2.3140290