Frontiers in Oncology · Oct 30, 2026
A 20 years Follow-up Results of the Modena Screening Program for Prostate Cancer (PCa) "Progetto Uomo"(PU)
By Maurizio Brausi, Giovanni Ferrari, Simone Morselli et al.
Background The last results of the European Randomized Study of Screening for Prostate Cancer (ERSPC), involving 182,160 men with up to 23 years of follow-up, demonstrated that repeated screening significantly reduces prostate cancer (PCa) specific mortality. In 1989, "Progetto Uomo" was launched in Modena, Italy, to evaluate the long-term impact of systematic PCa screening. Methods The program targeted asymptomatic men aged 50–75 years residing in the province of Modena. Participants received a standardized questionnaire addressing PCa family history, smoking habits, and lower urinary tract symptoms (LUTS). PSA testing and urine analysis were requested, and men were invited to attend one of nine urological centers for clinical evaluation, including DRE. PSA was introduced in the third year because at that time was not easily available. TRUS and prostate biopsy were performed when PSA levels exceeded 4 ng/ml or when DRE findings were suspicious. Data on PCa incidence and PCa-specific mortality were collected from the Modena Tumour Registry and compared between 1989 (pre-screening) and 2011–2012. Mortality rates were also compared with two neighbouring provinces, Reggio Emilia-Parma, where no organized screening was implemented. Results Between 1989 and 2008, 71,034 visits were performed on 39,840 men (mean age 63.2 years), with a participation rate of 56%. A total of 619 men (3%) underwent TRUS and biopsy for elevated PSA or suspicious DRE, with 269 cancers detected (43.5%), 182 (67.5%) of which were organ-confined. PCa incidence increased significantly, from 34.7 cases/100,000 inhabitants (1988–1990) to 78 cases/100,000 (2008) (p=0.001). Conversely, PCa-specific mortality decreased markedly, from 63 deaths/141.7 new cases/year (44.5%) in 1988–1990 to 155 deaths/899 new cases/year (17.2%) in 2011–2012, corresponding to a point decrease reduction of 27.3% (p=0.001). The 5-year relative survival for men with PCa increased from 62% (1988–1990) to 86.4% (1993–1999). Screening also led to incidental diagnoses of other malignancies and benign conditions, totalling 9,560 additional diagnoses (24%). Conclusions Progetto Uomo confirmed the ERSPC findings. Over 20 years, PCa incidence significantly increased, while mortality had a point decrease of 27.3%. This population-based program also improved cancer detection and facilitated management of benign urological conditions, highlighting the broader clinical benefits of organized PCa screening.