Nearly 300 abstracts on prostate cancer research from around the world will be presented at the European Association of Urology Congress (EAU26), taking place in London from 13–16 March 2026.
Highlights of some of the key advances in the prostate cancer screening field are detailed below.
Tobias Nordström is a clinical urologist and Associate Professor at the Karolinska Institute, Sweden and a member of the EAU Scientific Congress Office. He said: "The field of prostate cancer screening is advancing all the time. EAU26 provides us with a snapshot of where things are going.
"We know that screening can save lives. This year we have that confirmed with 30-year data from the longest running prostate cancer screening trial, led by a pioneer in the field, Jonas Hugosson. In the last ten years, research has focused on reducing overdiagnosis and unnecessary harms while maintaining the benefits in saving lives. A key tool for this is MRI, and we are now seeing research to evaluate how we can make best use of it in real world, clinical practice. But for all the buzz around new data, biomarkers or imaging, we must never forget that this is ultimately about people, about the men at risk of prostate cancer, about their lives and wellbeing. This is why research that confirms minimal harms from screening is also vital as we move forward."
Positive impact of screening on mortality increases over time, 30-year results show
Results from the longest-running European prostate cancer screening study confirm that screening leads to a reduction in mortality from prostate cancer, which becomes more pronounced over time.
The randomised controlled Gothenburg 1 study began in 1994 and involved 20,000 men aged 50–64. Half were invited every two years for PSA-testing until aged 70 and referred directly for systematic biopsy when their PSA was 3ng/ml or over. The other half were not invited to screening. Screening helped to avert one death for every 311 men invited to screening after 15 years, and for every 161 men after 30 years. Screening helped to avert one death for every 13 men diagnosed after 15 years and for every 6 men diagnosed after 30 years.
However, the study also registered a higher incidence of prostate cancer in the screening group compared to what would normally be expected.
Dr Jonas Hugosson, a senior researcher in the Department of Urology at the University of Gothenburg said: "This is the longest follow-up of any screening study and shows that the beneficial effect of screening on prostate cancer mortality continues to increase with time. However, it's also clear that screening detects cancers which would otherwise remain undetected and not be a cause for concern. This overdiagnosis may be due to the diagnostic pathway followed in the study, which has now been overtaken by the use of MRI and risk-stratification to reduce the number of insignificant cancers identified."
International expert consensus recommends faster, more targeted MRI scans in prostate cancer screening
Twenty-one experts including urologists, radiologists and pathologists from across Europe and North America have agreed an expert consensus on a smarter way to use MRI in prostate cancer screening.
Using MRI in accordance with the PRISM recommendations could detect significant prostate cancers while reducing overdiagnosis and unnecessary biopsies. The study, led by Imperial College London researchers, analysed existing research to draw up over 300 statements detailing when and how to best use MRI in prostate cancer screening, how the MRI should be interpreted, triggers for biopsy and when further screening MRIs are needed. Recommendations were drawn up based on the consensus view of the experts.
Nikhil Mayor, NIHR doctoral fellow at Imperial College London, is presenting the research at EAU26. He said: "MRI is key to diagnosing prostate cancer but there's no agreement as to how it should be used in population-level screening. We hope that the PRISM recommendations, backed by international expert consensus, will be widely adopted so that protocols are standardised for future screening pilots, studies and programmes. The recommendations will be applied in the landmark TRANSFORM prostate cancer screening trial which will use 10-minute, non-contrast 'Prostagram' MRI scans to screen up to 300,000 men."
Risk-based approach reduces MRI referrals for prostate cancer by up to 60%
MRI referrals can be reduced by 40–60% when risk stratification is used in addition to PSA alone, according to preliminary data from the PRAISE-U study. Previous studies have shown that up to 70% of MRIs may be unnecessary when PSA is used without additional risk stratification. Within the PRAISE‑U study, five European pilot sites are implementing a risk‑stratified prostate cancer screening algorithm for men aged 50–69 yrs.
Pilot sites use either PSA-density or the Rotterdam Prostate Cancer Risk calculator (RPCRC) to risk stratify following PSA, with various methods used to assess prostate volume (digital rectal examination, transrectal ultrasound, and transabdominal ultrasound). All risk stratification methods reduced the absolute number of MRI referrals. Centres using the RPCRC with transrectal ultrasound saw the greatest reduction in unnecessary MRIs.
Meike van Harten, PhD student at Erasmus MC Cancer Institute University Medical Centre in Rotterdam, The Netherlands, is presenting the data at EAU26. She said: "The implementation of population-based prostate cancer screening programs in Europe could result in around 5 million men being referred for MRI scans based on PSA solely. We need to find ways to reduce demand on MRI so that fewer men have unnecessary tests and those that need it get timely access to a diagnosis. PRAISE-U is showing how to identify a lower risk group of men who can safely avoid further tests, so only those most likely to have prostate cancer are referred for MRI."
Stockholm3 biomarker-based blood test reduces unnecessary MRI and biopsies
An advanced testing strategy designed to accurately detect aggressive prostate cancers can reduce the need for MRI referrals by 67% and biopsies by 40%.
A Sweden-based trial compared standard PSA test-based screening with PSA plus the Stockholm3 blood test, which uses an algorithm that combines protein and genetic biomarkers with clinical information. A total of 17,801 men were invited to organised prostate testing in 2023 and 30,556 in 2024. Of these, 13,733 men aged 50–52 yrs were included in the trial. It found that performing the Stockholm3 test before MRI in men with PSA 2 ng/ml or over led to 67% fewer MRI scans.
Professor Ugo Falagario, Professor of Urology at the University of Foggia, Italy, a co-investigator on the trial, is presenting the data at EAU26. He said: "Since rolling out prostate cancer screening programmes across most Swedish regions, the call on MRI scans is very high. Stockholm3 has already been shown as a beneficial approach in detecting prostate cancer. We now demonstrate it can be implemented in population-based organised prostate testing to identify only those with potentially higher-risk cancers who require a referral for an MRI scan and a biopsy – significantly reducing the demand on imaging services."
Worry is common in prostate cancer screening, but severe anxiety is rare
Around a quarter of men who have a high PSA during prostate cancer screening feel worried in the run-up to biopsy, but very few have more severe anxiety, new research has found.
692 men with an elevated PSA value were questioned about their levels of anxiety, depression, distress and worry during the Göteborg-2 prostate cancer screening trial in Sweden. 3.8–4.8% of men reported moderate to severe anxiety after referral for MRI and biopsy. The greatest impact was just before biopsy, when 9.7% of men reported distress and 26% said they felt worried, with 4.2% saying it affected their daily life.
Dr Linda Svensson, specialist nurse in oncology at the Department of Urology, Sahlgrenska University Hospital, Sweden, is presenting the research at EAU26. She said: "One of the concerns around prostate cancer screening is the balance between benefits and harms for men taking part, including psychological harm. It's natural for men to feel worried if they have a high PSA and are referred for diagnostic investigation, but our study shows that severe anxiety symptoms are rare. This shows that there is a low risk of psychological harm from modern prostate cancer screening programmes."
