Current Oncology Reports · Oct 27, 2026
Early Detection of Prostate Cancer: Advances in Screening, Biomarkers, and Imaging Strategies
By Anya O, Chikere O, Breen P et al.
PURPOSE OF REVIEW: This review synthesizes the complete early detection pathway for prostate cancer; from initial PSA testing through advanced biomarkers, imaging, and biopsy techniques, into an integrated, risk-adapted clinical framework designed for internists and primary care physicians. RECENT FINDINGS: Current approaches to prostate cancer screening include PSA-based testing, blood-based biomarkers, and imaging with multiparametric MRI (mpMRI). PSA-based screening reduces prostate cancer-specific mortality but remains limited by overdiagnosis and low specificity. Advanced biomarkers, including the Prostate Health Index (PHI), 4Kscore, and prostate cancer antigen 3 (PCA3), improve risk stratification and support more appropriate biopsy decisions. mpMRI achieves sensitivity of 85-93% for clinically significant disease and, when combined with MRI-targeted biopsy, enhances detection of aggressive tumors while reducing identification of indolent disease. However, adoption of these technologies is constrained by cost, availability, and variability in reader expertise across clinical settings. PSA-based screening reduces prostate cancer-specific mortality (rate ratio 0.87; 95% CI, 0.80-0.95 at 23-year follow-up in the ERSPC trial) but remains limited by overdiagnosis and low specificity. Advanced biomarkers, including the Prostate Health Index (PHI), 4Kscore, and prostate cancer antigen 3 (PCA3), improve risk stratification and support more appropriate biopsy decisions. Multiparametric MRI (mpMRI) achieves sensitivity of 85-93% for clinically significant disease and, combined with MRI-targeted biopsy, enhances detection of aggressive tumors while reducing identification of indolent disease. However, adoption of these technologies is constrained by cost, availability, and variability in reader expertise across clinical settings. Current prostate cancer screening strategies, including prostate-specific antigen (PSA) testing and digital rectal examination (DRE), have contributed to earlier detection but remain limited by false-positive results, overdiagnosis, and variability in screening practices. The incorporation of secondary biomarkers and multiparametric MRI (mpMRI) has improved risk stratification and may help reduce unnecessary biopsies, although access and implementation remain inconsistent. Future screening strategies are expected to increasingly integrate artificial intelligence-assisted imaging and polygenic risk scores to enable more personalized, equitable, and risk-adapted prostate cancer screening. Effective implementation will require addressing persistent disparities in access to advanced diagnostic technologies.