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A New Technique for Treating Low-risk Prostate Cancer&#8212;Super Active Surveillance
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Published on: November 7, 2025

Prostate Cancer Screening in Contemporary Era: PSA-Based Testing and Risk-Adapted Approaches.

Michele Brancaccio1, Armando Galdieri1, Andrea Cosenza1

  • 1Division of Urology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.

Cancers
|May 27, 2026
PubMed
Summary
This summary is machine-generated.

Modern prostate cancer (PCa) screening moves beyond PSA testing to risk-adapted strategies. Integrating MRI and biomarkers improves detection of significant disease while reducing unnecessary interventions for better patient outcomes.

Keywords:
active surveillancemagnetic resonance imagingpolygenic risk scoresprostate cancerprostate-specific antigenscreening

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Area of Science:

  • Oncology
  • Urology
  • Diagnostic Imaging

Background:

  • Prostate cancer (PCa) screening historically relied on PSA testing, leading to overdiagnosis and overtreatment.
  • Contemporary diagnostic workflows now include advanced imaging, biopsy techniques, and risk-adapted management.
  • There is a need to re-evaluate historical screening evidence within current clinical practices.

Purpose of the Study:

  • To review the evolution of PCa screening from PSA-only to modern, risk-adapted strategies.
  • To synthesize evidence for integrating multiparametric MRI (mpMRI), refined biopsies, and active surveillance (AS).
  • To discuss the role of biomarkers and recent regulatory developments in personalized PCa screening.

Main Methods:

  • Narrative review synthesizing evidence from randomized trials and emerging innovations.
  • Focus on second-line MRI-based approaches for diagnostic precision.
  • Examination of blood-based and genomic biomarkers for pre-biopsy risk stratification.

Main Results:

  • mpMRI and refined biopsy techniques enhance detection of clinically significant PCa while minimizing unnecessary interventions.
  • Second-line MRI-based strategies significantly reduce avoidable biopsies and improve diagnostic accuracy.
  • Biomarkers and novel PSA assays support individualized screening, representing an evolution rather than a paradigm shift.

Conclusions:

  • PCa screening is transitioning towards personalized, harm-aware strategies.
  • Integration of advanced imaging (mpMRI) and biomarkers is crucial for optimizing early detection.
  • Modern screening aims to improve detection of significant disease and reduce overtreatment.