Comparison of results from the BARCODE1 study and contemporary prostate cancer screening trials

Journal article

Polygenic risk scores (PRS) have generated considerable interest as a means of personalizing prostate cancer screening by stratifying individuals according to genetic risk. BARCODE1, a single-arm study, recently concluded that PRS-based screening detected more cancers than prostate-specific antigen (PSA) testing or magnetic resonance imaging (MRI). The absence of a comparator arm limits the interpretability of this finding. We compared outcomes from BARCODE1 with those from two contemporaneous, large-scale screening trials—Göteborg-2 and ProScreen—which used MRI with or without a prostate cancer blood marker to risk-stratify men for biopsy. When standardized to 10,000 men tested, BARCODE1 biopsied more men (704 vs. 386 and 338), diagnosed more low-grade cancers (126 vs. 103 and 41) and detected fewer high-grade cancers (155 vs. 178 and 165) compared to Göteborg-2 and ProScreen. Combining PRS with PSA or MRI in BARCODE1, reduced the detection of high-grade cancers by 50-75% compared to Göteborg-2 and ProScreen. These findings reflect the limited risk discrimination of PRS and their inability, unlike MRI and blood-based markers, to preferentially detect aggressive disease. PRS-based prostate cancer screening underperforms relative to current best practice and, based on BARCODE1 data, should not be adopted into clinical practice.

Authors: Sud, A; McNeill, A; Vickers, AJ

• Publication status: In press
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: European Urology Oncology
• Publication date: 2025-12-31
• Acceptance date: 2025-12-18
• DOI: 10.1016/j.euo.2025.12.013
• EISSN: 2588-9311
• Language: English
• Keywords: prostate cancer; screening; polygenic risk score