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Transperineal Prostate Biopsy Using a Cone-shaped Double-hole Method with Dual-plane Probe Guidance
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The Proposed Introduction of a Prostate Cancer Screening Program in Germany: Procedure, Necessary Studies before

Peter Albers, Sigrid Carlsson, Agne Krilaviciute

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    PubMed
    Summary

    Risk-adapted prostate cancer screening starting at age 45-50, using prostate-specific antigen (PSA) and MRI, offers a better benefit-to-harm ratio. This approach reduces overdiagnosis compared to broader screening programs.

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    Area of Science:

    • Urology
    • Oncology
    • Public Health

    Background:

    • New German S3 guideline (2025) and EU recommendations (2022) advocate for risk-adapted early prostate cancer detection.
    • Prostate-specific antigen (PSA) testing combined with magnetic resonance imaging (MRI) are key components of recommended screening strategies.

    Purpose of the Study:

    • To review available screening instruments for prostate cancer.
    • To discuss implications of different methods for implementing a German prostate cancer screening program.

    Main Methods:

    • Narrative review based on literature search from November 2024 to November 2025.
    • Analysis of screening instruments and their implications for program implementation.

    Main Results:

    • Risk-adapted screening (PSA + MRI) from age 45-50 reduces indolent prostate cancer from ~50% to 24%.
    • Clinically relevant prostate cancer incidence is 0.6%, comparable to breast cancer screening.
    • Screening at older ages increases overdiagnosis and is likely not cost-efficient.

    Conclusions:

    • Prostate cancer screening with a risk-adapted concept starting at age 45-50 has a superior benefit-to-harm ratio.
    • This approach is preferable to wide-range or opportunistic screening programs.
    • Further implementation studies and cost-efficiency analyses are required before organized screening.