EAU26 Congress Highlights Major Strides in Prostate Cancer Research
The European Association of Urology Congress (EAU26), held in London from March 13–16, 2026, served as a crucial platform for presenting nearly 300 abstracts on prostate cancer research. Key presentations highlighted significant advancements in long-term screening benefits, improved diagnostic accuracy, strategies to reduce overdiagnosis, and the introduction of a promising new imaging test that may significantly reduce the need for biopsies.
Advances in Prostate Cancer Screening Strategies
Long-Term Screening Benefits Confirmed
Results from the Gothenburg 1 study, the longest-running European prostate cancer screening trial, were presented after 30 years of observation. This randomized controlled study, initiated in 1994 with 20,000 men aged 50–64, indicated that screening contributes to a reduction in prostate cancer mortality, with the benefit increasing over time.
The study reported that one death was averted for every 161 men invited for screening.
Researchers also noted a higher incidence of prostate cancer in the screening group, which was attributed to overdiagnosis resulting from older diagnostic pathways. Current methods like MRI and risk stratification were noted as improvements.
International Consensus on MRI Use
An international panel of 21 experts from Europe and North America developed the PRISM recommendations, a consensus on the more effective integration of MRI into prostate cancer screening protocols. These guidelines aim to identify significant prostate cancers while minimizing overdiagnosis and unnecessary biopsies. The recommendations encompass optimal MRI usage, interpretation, biopsy triggers, and follow-up screening.
The PRISM recommendations are scheduled for implementation in the TRANSFORM prostate cancer screening trial, which plans to utilize 10-minute 'Prostagram' MRI scans for up to 300,000 men.
Risk-Based Screening Reduces MRI Referrals
Preliminary data from the PRAISE-U study suggest that incorporating risk stratification methods alongside PSA testing can reduce MRI referrals for prostate cancer by 40–60%. Five European pilot sites are implementing a risk-stratified screening algorithm for men aged 50–69. This approach uses either PSA-density or the Rotterdam Prostate Cancer Risk Calculator (RPCRC) following an initial PSA test.
The RPCRC, when combined with transrectal ultrasound, demonstrated the most significant reduction in unnecessary MRI procedures. This strategy seeks to alleviate demand on MRI services and potentially facilitate timely diagnosis for men at higher risk of prostate cancer.
Stockholm3 Blood Test Enhances Detection Efficiency
A Swedish trial involving 13,733 men aged 50–52 investigated an advanced testing strategy utilizing the Stockholm3 blood test. This test combines protein and genetic biomarkers with clinical information. The trial indicated that performing the Stockholm3 test before an MRI in men with a PSA of 2 ng/ml or higher could reduce the need for MRI referrals by 67% and biopsies by 40%. This method aims to identify men with potentially higher-risk cancers, potentially reducing the burden on imaging services within organized screening programs.
Psychological Impact of Screening
Research from the Göteborg-2 prostate cancer screening trial examined the psychological effects associated with screening. The study, which included 692 men, found that while worry was common (26% before biopsy) among men with an elevated PSA value, severe anxiety was reported infrequently, affecting 3.8–4.8% after referral for MRI and biopsy.
The findings suggest a low risk of significant psychological harm from modern prostate cancer screening programs, despite natural concerns during diagnostic investigations.
PSMA PET/CT Scan: Reducing Biopsies
Findings from the Australia-wide PRIMARY2 phase III clinical trial were also presented at the congress. The trial demonstrated that the PSMA PET/CT scan, a new imaging test, can safely reduce by half the number of individuals requiring a biopsy for suspected prostate cancer following inconclusive or reassuring MRI results.
Functionality and Trial Results
The PSMA PET/CT scan operates by identifying aggressive prostate cancer cells, which appear as bright spots on the image due to a binding molecule. This scan also aids in identifying low-risk cancers that may not require treatment, potentially contributing to a reduction in overdiagnosis.
The PRIMARY2 trial enrolled 660 individuals at higher risk of prostate cancer who had normal MRI results. Participants were randomized to either receive a standard biopsy or a PSMA PET/CT scan. The study concluded that PSMA PET/CT scanning identified individuals who either did not have cancer or had very low-risk cancer, thereby eliminating the need for a biopsy in half of the cases, without missing any harmful cancers.
For patients who still required a biopsy, the scan results facilitated targeted procedures, which aimed to enhance accuracy and minimize complications.
Context and Accessibility
The typical diagnostic process for suspected prostate cancer involves an MRI scan to identify abnormal areas. If MRI results are suspicious or inconclusive, a biopsy is performed to analyze prostate tissue for cancer cells. Biopsies are invasive procedures associated with discomfort and potential side effects.
The PRIMARY2 trial was co-led by the Peter MacCallum Cancer Centre in Melbourne and St Vincent's Hospital in Sydney. PSMA PET/CT scanning is widely available in Australia, and its accessibility is increasing in the UK and Europe, though cost and availability remain considerations. The trial will continue to follow these patients for two years.