Prostate cancer screening offers a broadly similar rate of invasive cancer detection to breast cancer screening but generates a substantially higher number of false positives, new research has shown.

The findings have sparked further debate on the clinical value of prostate cancer screening and the tension between early detection and overdiagnosis.

An analysis presented at the European Association of Urology Congress 2026 drew on results from the recent German PROBASE trial, in which men aged 45 years (n=23,301) or 50 years (n=16,091) with PSA ≥3 ng/mL underwent MRI and biopsy.

Outcomes were compared with those from Germany’s population-based mammography programme involving women aged 50-69 years (n=2,845,747).

The analysis showed that a similar proportion of patients were referred for biopsy following breast and prostate cancer screening.

In addition, detection of invasive of high-grade disease was also similar, with around 70% of cancers classified as clinically significant in each programme.

The positive predictive value of prostate cancer was higher for prostate than breast cancer screening potentially indicating a greater diagnostic yield. However, prostate cancer screening also identified more non-aggressive cancers and had a much higher rate of false positives.

Final results showed that:

• The rate of indication for biopsy was similar for prostate and breast cancer screening (45-years: 0.8% and 50-years: 2.4% vs 1.1%)
• False positives were far higher for prostate cancer screening (45-years: 42% and 50-years: 37% vs 10%)
• Positive predictive value of biopsy was higher for prostate screening than mammography (45-years: 50% and 50-years: 68% vs 15%)
• Most cancers were invasive or high-grade in both programmes (prostate: 69–74% vs breast: 73%)
• Detection of indolent tumours was slightly higher for prostate than breast cancer screening (45-years: 31% and 50-years: 26% vs 22%).

According to the investigators, the findings “support implementation of organised, risk-adapted prostate screening programmes, with cost-effectiveness and rigorous evaluation as essential components for sustainable, population-level application”.

They also suggested that use of active surveillance in prostate cancer would mitigate the possibility of overtreatment due to false positives.

“Until we have a population-based screening programme for prostate cancer, we can’t make an exact like-for-like comparison with breast cancer,” said lead author Dr Sigrid Carlsson, leader of the Clinical Epidemiology of Early Cancer Detection, German Cancer Research Centre, Germany.

“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,” she said.

However, others disagreed with this interpretation. Dr Alastair Lamb, a Clinical Reader at Barts Cancer Institute, questioned the choice of comparator “given that not many experts would claim breast-screening as a success”.

He said the PROBASE team had shown that prostate cancer screening “delivers too many false positives,” and that, as the debate on what constitutes a life-altering diagnosis continues, “it is hard to concur with the authors conclusion that their study supports implementation of prostate cancer screening”.

In addition, he highlighted key differences in the downstream risk from treatment for breast and prostate cancers.

“Giving people a diagnosis of cancer can deliver psychological harms and may alter behaviour (e.g. choosing treatment when you don’t need it). The big difference is that breast cancer treatment itself, (e.g. surgery) rarely causes harm – although it certainly can cause aesthetic/psychological impact – whereas pretty much all prostate cancer treatment can cause many functional harms e.g. bladder/bowel/erectile dysfunction,” he noted.

Simon Grieveson, Assistant Director of Research at Prostate Cancer UK, said the results should not change the National Screening Committee’s recent verdict to reject a prostate cancer screening program, despite criticism over the decision.

“Whilst this study has revealed some interesting correlations, unfortunately, there still is not enough evidence here to prove that introducing screening will save the lives of men with aggressive cancer while also protecting men with slow-growing cancer from potentially harmful treatments they don’t even need,” he said.