The Proposed Introduction of a Prostate Cancer Screening Program in Germany: Procedure, Necessary Studies before Implementation, Benefits, and Risks.

Abstract

Both the new German S3 guideline on prostate cancer (2025) and the European Union (2022) recommend risk-adapted early detection of prostate cancer by measurement of the prostate-specific antigen (PSA) level combined with magnetic resonance imaging (MRI).In this article, we describe the available screening instruments and the implications of various different methods that might be used for the introduction of a prostate cancer screening program in Germany. This narrative review is based on pertinent publications that were retrieved by a literature search from November 2024 to November 2025. Compared to purely PSA-based screening, a PSA-based, risk-adapted screening program lowers the incidence of clinically indolent prostate cancer (ISUP gradation group 1) from approximately 50% to 24% if begun at age 45-50. The cumulative incidence of clinically relevant prostate cancer is 0.6% and thus comparable to the detection rate of breast cancer screening in patients of this age group. Prostate cancer screening starting at an older age increases the number of overdiagnoses leading to unnecessary treatment and is in all likelihood not cost-efficient. Prostate cancer screening that starts at age 45-50 and proceeds on the basis of a risk-adapted concept has a better benefit-to-harm ratio than a screening program introduced all at once over a wide age range (e.g., 50-70) or opportunistic screening (i.e., no organized screening program). Implementation studies and model calculations on cost-efficiency are needed before organized screening can begin.