Jonas Hugosson, MD, presented “Update on Göteborg-2 Trial: PSA Screening Followed by MRI” during the 9th Global Summit on Precision Diagnosis and Treatment of Prostate Cancer on September 15, 2025.
How to cite: Hugosson, Jonas. “Update on Göteborg-2 Trial: PSA Screening Followed by MRI.” September 15, 2025. Accessed Feb 2026. https://grandroundsinurology.com/update-on-goteborg-2-trial-psa-screening-followed-by-mri/
Update on Göteborg-2 Trial: PSA Screening Followed by MRI – Summary
Jonas Hugosson, MD, Professor of Urology, Sahlgrenska Academy, University of Gothenburg, Sweden, presented follow-up findings from the Göteborg-2 randomized screening trial. The study evaluates whether replacing systematic biopsies with magnetic resonance imaging (MRI)-directed targeted biopsies after elevated prostate-specific antigen (PSA) can reduce overdiagnosis.
In the trial, men from the population registry were randomized to a control group or screening, with further randomization into three arms. Arm 1 used PSA ≥3 ng/mL followed by MRI and systematic and targeted biopsies. Arm 2 used PSA ≥3 ng/mL but performed biopsy only if MRI was positive with a prostate imaging reporting and data system (PI-RADS) score of 3–5. Arm 3 was similar to Arm 2 but used a lower PSA cutoff of 1.8 ng/mL to trigger MRI.
The initial analysis, published in the New England Journal of Medicine in 2022, showed that restricting biopsy to MRI-positive men reduced biopsy rates by nearly 60 percent and cut detection of clinically insignificant cancers by 50 percent compared with systematic biopsy while maintaining detection of clinically significant cancers. Few intermediate-risk cancers were missed in MRI-negative men, most of which were low-volume and managed with active surveillance.
Follow-up results confirmed durable reductions in the detection of clinically insignificant cancers, with no evidence of increased rates of high-risk or metastatic cancers in the MRI-targeted biopsy arm. These findings suggest MRI-based screening substantially reduces overdiagnosis without compromising the detection of aggressive disease.
Dr. Hugosson shares that ongoing analyses include an 8-year follow-up comparing cumulative incidence across trial arms, a head-to-head comparison of PSA cutoffs (3 ng/mL vs 1.8 ng/mL), and the first prostate cancer mortality analysis, expected in 2028.
The Global Summit on Precision Diagnosis and Treatment of Prostate Cancer is a unique multi-disciplinary forum organized to inform the key health care stakeholders about the emerging advances in clinical case and research and create a consensus-based vision for the future of precision care and educational and research strategy for its realization. The mission of the Summit is to fill the currently existing gap between the key experts of in vivo imaging, the world authorities in the in vitro fluid- and tissue-based molecular diagnostics, including genomics, and thought leaders in the development of novel observation strategies (e.g., active surveillance, or AS) and therapeutic interventions.
ABOUT THE AUTHOR
Jonas Hugosson, MD, is a Senior Researcher and a Professor in the Urology Department at the University of Gothenburg in Göteborg, Sweden. Dr. Hugosson earned his medical degree from the University of Gothenburg. He specializes in prostate cancer and urologic surgery. Dr. Hugosson has served as a physician in Sahlgrenska Hospital and Östra Hospital in the Department of Surgery, Urology, and Anaesthesia.
