A new analysis suggests that prostate cancer screening may compare favorably with screening for breast cancer in terms of identifying significant cancers, reducing mortality, and avoiding unnecessary harms, according to findings presented at the 2026 Annual Congress of the European Association of Urology (Abstract A0416). The research is also due to be published in European Urology.
“Until we have a population-based screening program for prostate cancer, we can’t make an exact like-for-like comparison with breast cancer. But we can make some informed assumptions based on the data from our trial, which shows that if prostate cancer screening were extended to the wider population, then the outcomes are likely to be very similar to breast cancer. Although our study used German data, the findings are applicable to other countries,” said lead study author Sigrid V. Carlsson, MD, PhD, MPH, Division Head of the Clinical Epidemiology of Early Cancer Detection at the German Cancer Research Centre (DKFZ) in Heidelberg. “The final question we now need to answer is: what will this cost compared to what we are already paying for opportunistic screening? And that work is already underway.”
Background and Study Methods
Organized, national screening programs have been implemented in many countries to identify breast cancers, but the same has not occurred for prostate cancer. Concerns remain about the effectiveness of the prostate-specific antigen (PSA) blood test for screening for prostate cancer as well as the potential for overdiagnosis and overtreatment.
Several countries in Europe have reported that there is a reduced risk of death from prostate cancer with PSA testing from a randomized study of prostate cancer screenings, which was maintained with long-term follow-up out to 23 years. The trials also showed an improved harm–benefit ratio.
In an analysis, researchers compared prostate cancer screening with breast cancer screening in terms of effectiveness of diagnostic testing and the amount of overdiagnosis. Data came from the PROBASE prostate cancer screening trial in Germany, which included 39,392 men who underwent an initial PSA blood test at age 45 or 50 years, and Germany's national breast cancer screening program, which included more than 2.8 million women between the ages of 50 and 69 years who had a mammography through the national program.
Key Findings
A PSA blood test followed by a magnetic resonance imaging (MRI) scan led to more false positives (37% to 42%) than mammography (10%).
A similar number of men (0.8% to 2.4%) and women (1.1%) were referred for biopsy, as men in the PROBASE trial were triaged before referral for risk stratification.
Significantly more biopsies identified significant cancers from prostate cancer screening (50% to 68%) than with breast cancer screening (10%), which reflected that fewer men underwent unnecessary biopsies. Similar rates of invasive cancers were found with both screening programs, 60% to 74% with prostate cancer screening and 73% with breast cancer screening.
Nonaggressive cancers were more likely to be found with prostate cancer screening (26% to 31%) than with breast cancer screening (22%). Researchers suggested that active surveillance in prostate cancer would limit the risk of overtreatment of these nonaggressive cancers.
“There is much that prostate cancer screening can learn from breast cancer screening and that is why this analysis is an important addition to our knowledge base. As these kinds of comparisons are very challenging, the results do need to be taken with a level of caution. That said, the clear overall similarities between the outcomes for breast and prostate cancer screening show that we are moving in the right direction, ensuring prostate cancer screening offers more benefits than harm,” stated Tobias Nordström, MD, PhD, Clinical Urologist and Associate Professor at the Karolinska Institute, Sweden and a Member of the EAU Scientific Congress Office.
DISCLOSURE: For full disclosures of the study authors, visit urosource.uroweb.org.
