Prostate cancer screening beyond opportunistic testing: A Delphi consensus and evidence integration

Prostate cancer has become the most common male malignancy in Korea, yet prostate-specific antigen (PSA)-based screening remains excluded from the national cancer screening program and is performed predominantly on an opportunistic basis. Long-term randomized evidence comparing organized PSA-based screening with opportunistic testing is complex and variably interpreted. This study aimed to assess expert consensus on whether an organized early-detection framework offers advantages over the current opportunistic model in Korea.

A structured, three-round Delphi study was conducted among 15 Korean urologists with expertise in prostate cancer management and PSA-based early detection. Statements were informed by international guidelines, long-term randomized trial evidence, and Korean epidemiologic data, covering conceptual justification and screening parameters. Consensus was predefined using Likert-scale agreement/disagreement thresholds and a within-group agreement index (r_wg ≥0.80).

All panelists completed all three rounds. Consensus was achieved that PSA-based early detection provides a net population-level benefit; that organized, invitation-based screening is preferable to opportunistic testing; and that active surveillance should be the default for low-risk disease. Initiation at age 55 reached stable consensus, whereas discontinuation at age 80 reached consensus only in the final round, indicating an upper bound within an individualized 75- to 80-year stopping range. No fixed screening interval achieved sustained agreement, supporting risk-adapted approaches.

This Delphi study supports the feasibility of an organized, risk-adapted PSA-based early detection framework in Korea. Subsequent multidisciplinary input from preventive medicine, primary care, health economics, and patient perspectives is required before policy implementation.