A New Era in Prostate Cancer Detection
In 2012, when the US Preventive Services Task Force (USPSTF) recommended against PSA screening, Dr. Catalona and colleagues responded in an article titled What the U.S. Preventive Services Task Force Missed in Its Prostate Cancer Screening Recommendation, “The recommendations of the USPSTF carry considerable weight with Medicare and other third-party insurers and could affect the health and lives of men at high risk for life-threatening disease. We believe that eliminating reimbursement for PSA testing would take us back to an era when prostate cancer was often discovered at advanced andincurable stages. ” Catalona WJ et al, Ann Int Med 2012 ;157:137-8.
In a September 2025 news release from Dr. David Jarrard, Vice-Chair of the Department of Urology of the University of Wisconsin (UW), Principal Investigator on the UW Prostate SPORE, and member of the NCI Genitourinary Cancers Steering Committee’s Prostate Task Force, reported that this concern has clearly materialized. Dr. Jarrard’s article is reprinted below.
A New Era in Prostate Cancer Detection
by David Jarrard, MD
Recent data shows a concerning trend: more men in the U.S. are being diagnosed with advanced or metastatic prostate cancer –meaning the disease has already spread beyond the prostate at the time of diagnosis. A national study of cases diagnosed between 2011 and 2019 demonstrated a 4.5% increase in advanced disease. Worse, mortality rates – which had been dropping by 2.6% annually from 2004 to 2012 – leveled off from 2012 to 2021.
This shift appears to align with the 2012 recommendation by the U.S. Preventive Services Task Force (USPSTF) against routine PSA (Prostate-Specific Antigen) screening. Since then, cases of metastatic prostate cancer have been slowly but steadily rising. Forecast models from earlier data project an increase in metastatic incidence by 1–2% per year through 2025 – potentially leading to thousands more men being diagnosed at a later, harder-to-treat stage.
PSA testing has long been the foundation of prostate cancer screening. It’s a simple, inexpensive blood test – but it has its drawbacks.Studies show PSA tests can be highly sensitive (up to 94%) but are not very specific (as low as 15–26%). Factorslike benign prostatic hyperplasia, prostatitis, and other variables confound PSA levels and contribute to frequent false-positive results.
Even more concerning – PSA can miss aggressive cancers. About 15% of men with “normal” PSA levels (below 4 ng/mL) still have high-grade disease. Yet, despite its limitations, PSA remains widely used because of its simplicity and affordability.
Going forward, the future of improved prostate cancer screening lies in a more personalized, technology- driven approach that integrates advanced imaging, novel biomarkers, and risk-adapted strategies.
One of the most significant breakthroughs in recent years is Multiparametric MRI (mpMRI). Trials like “PROMIS” and “PRECISION” have shown that mpMRI can reduce unnecessary biopsies by as much as 27%, while increasing detection of clinically significant cancers. Further, MRI-targeted biopsies missed fewer aggressive lesions than systematic biopsies.
At the recent American Urological Association national meeting, UW Urology presented results from the “PROMPT” trial, which tested a new hybrid imaging approach combining PSMA PET with MRI to further boost the specificity of detecting clinically significant prostate cancer in patients. PSMA PET is a newer imaging approach primarily used in staging advanced prostate cancer, but our team has been testing its potential in earlier-stage diagnosis. For this study, our team utilized the industry’s first integrated PET/MR scanner (GE Healthcare in Racine, WI), which enables on-device fusion of MRI and PET images, thereby improving the accuracy of locatinghigh-risk cancer lesions.
Novel machine learning tools also show promise: recent AI frameworks that fuse MRI and ultrasound inputs demonstrate improved sensitivity and specificity relative to radiologists, helping to identify cancers more accurately and consistently.
While new imaging approaches continue to advance, identification of molecular biomarkers – substances in the body that can give clues about the presence and aggressiveness of cancer – is crucial for more precise prostate cancer risk assessment.
Currently, blood tests like the Prostate Health Index (PHI) and 4Kscore combine PSA with other blood-based markers to provide more detailed risk assessments. However, these still represent only modest improvements in risk prediction. One particularly exciting area of research,based on work previously published2, has been examining seminal fluid to detect prostate cancer. In a recent trial performed in conjunction with Gregor Diagnostics (Madison, WI), at-home collection of seminal fluid was used to detect prostate cancer. Early results suggest this method could dramatically improve both detection and the ability to rule out serious disease.
Technologies such as multiplex protein assays, mass spectrometry, and antibody arrays are being developed to enhance diagnostic accuracy. However, challenges remain – particularly around cost, standardization, and integrating them into everyday clinical practice.
The next generation of prostate cancer screening will most certainly not rely on a single test. A multi-modal screening strategy – combining PSA-based evaluation, refined biomarkers, risk calculators, advanced imaging (e.g., mpMRI, PSMA PET), and AI-driven lesion characterization – holds the most promise for detecting aggressive cancers early, when they’re still curable, while avoiding theovertreatment of harmless tumors.
Posted in David Jarrard, Research. Posted on September 11, 2025. Reprinted with the permission of Dr. Jarrard.
