Risk-adapted prostate cancer screening using PSA testing followed by MRI and targeted biopsy can achieve performance metrics comparable to established mammography programs, according to results from the PROBASE trial presented at the European Association of Urology (EAU) Congress.
Researchers analyzed population-level screening outcomes from the German PROBASE study, which enrolled around 46,000 men aged 45 or 50 years, and compared them with data from Germany’s national mammography screening program for breast cancer. The aim was to assess whether modern prostate cancer screening strategies can deliver benefits similar to those achieved by organized breast cancer screening programs.
Historically, organized prostate cancer screening has been controversial because earlier PSA-based approaches led to high rates of overdiagnosis and overtreatment. The PROBASE strategy instead uses a risk-adapted pathway: men first undergo baseline PSA testing, and only those with PSA levels of at least 3 ng/mL proceed to MRI and biopsy. Men with lower PSA levels return for repeat testing at longer intervals.
Participation in both programs was high, with tens of thousands of men taking part in the prostate screening program each year. Notably, the positive predictive value of biopsy was substantially higher in the prostate screening model than in mammography follow-up procedures. Biopsy predictive values ranged from 50 to 68 percent for prostate cancer, compared with around 15 percent for breast screening.
False-positive findings were more frequent in prostate cancer screening – between 37 and 42 percent compared with roughly 10 percent in mammography. However, most cancers detected through both screening programs were clinically significant. Invasive or high-grade disease accounted for 69 to 74 percent of prostate cancers detected, compared with 73 percent of breast cancers.
Detection of indolent tumors was slightly higher in prostate screening. The authors note that the use of active surveillance for low-risk disease helps reduce the risk of overtreatment, a major criticism of earlier PSA-based screening programs.
The findings highlight the growing role of integrated screening pathways combining biomarkers, imaging, and risk stratification. The results suggest that PSA testing, when used as an initial triage tool within a structured program that incorporates MRI and selective biopsy, may deliver population-level benefits similar to those seen with mammography.
Lead researcher Sigrid Carlsson, from the German Cancer Research Centre in Heidelberg, said, "Although our study used German data, the findings are applicable to other countries. 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."
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