Screening for prostate cancer: evidence, ongoing trials, policies and knowledge gaps

Area of Science:

• Urology
• Oncology
• Preventive Medicine

Background:

• Prostate cancer screening with PSA and biopsies reduces mortality but causes overdiagnosis.
• Advances in diagnostics and understanding of low-grade prostate cancer enable more selective detection.

Purpose of the Study:

• To review diagnostic advances, screening trials, policies, and knowledge gaps in prostate cancer detection.
• To inform strategies for reducing overdiagnosis while maintaining mortality benefits.

Main Methods:

• Non-systematic review of diagnostic methods, screening trials, and healthcare policies.
• Synthesis of evidence on serum PSA, risk calculators, biomarkers, and MRI for prostate cancer diagnosis.

Main Results:

• Low serum PSA levels permit adjusted screening intervals.
• Risk calculators, biomarkers, and MRI-guided biopsies reduce low-grade cancer detection and overdiagnosis.
• European Union recommends evaluating organized prostate cancer screening programs.

Conclusions:

• Modern diagnostic tools can significantly reduce overdiagnosis in prostate cancer screening.
• Ongoing trials and pilot programs are crucial for addressing remaining knowledge gaps on long-term effectiveness and mortality impact.