A Pragmatic Approach to Prostate Cancer Screening

A pragmatic approach to prostate cancer screening has evolved over the years to address the harms associated with traditional screening methods. The introduction of PSA-based screening in the 1990s led to a decline in prostate cancer metastasis and mortality, but it also resulted in substantial harms due to overdiagnosis and overtreatment. In 2012, the US Preventive Services Task Force recommended against the use of PSA screening. However, longer-term outcomes from high-quality studies have provided better insights into the benefits of screening. Advances in understanding prostate cancer have also led to the adoption of active surveillance as a management strategy for favorable-risk cancers. Current guidelines recommend a narrowed diagnostic focus, with the use of MRI or biomarker testing to better define the risk of high-grade disease prior to biopsy. The use of biomarkers followed by MRI has shown promise in improving the detection of high-grade cancers. A recent study in Finland demonstrated the effectiveness of this approach, achieving a high yield of biopsy and reducing the overdiagnosis of low-grade disease. However, there are still knowledge gaps regarding the need for systematic biopsy in patients with positive or negative MRI results.