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Background <p>Early detection of prostate cancer (PCa) remains a&#xa0;controversial topic. Prostate-specific antigen (PSA)-based screening can reduce PCa mortality, but is debated due to the limited specificity of the test, which often results in overdiagnosis and overtreatment of clinically irrelevant PCa.</p> Objective <p>This review article presents the current evidence on PCa screening, with a&#xa0;particular focus on imaging diagnostics.</p> Results <p>The current German early detection program is based on digital rectal examination (DRE), but its specificity and sensitivity are insufficient. Instead of a&#xa0;structured program, Germany applies opportunistic PSA screening, which is not recommended due to an unfavorable benefit–risk ratio. Since 2022, the European Commission has called for organized, risk-adjusted screening programs that combine PSA tests with magnetic resonance imaging (MRI). MRI increases accuracy by better detection of clinically relevant PCa while simultaneously reducing overdiagnosis of low-risk tumors. An optimal PCa screening program should be personalized, systematically organized, and evidence based. In addition to PSA tests and MRI, genetic markers could also be integrated to further improve early detection.</p> Conclusion <p>An organized, risk-adjusted screening program that combines PSA testing with MRI could improve the benefit–risk ratio of PCa early detection. Key elements include population-wide invitations, adjustment to individual risk factors, and quality assurance in MRI.</p>

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Früherkennung und moderne bildgebende Diagnostik des Prostatakarzinoms

  • 期刊论文

  • 发表日期：

    2025年6月23日

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  • Isabelle Bußhoff,
  • Anne Hübner,
  • Rouvier Al-Monajjed,
  • Jale Lakes,
  • Jan Philipp Radtke,
  • Peter Albers

摘要

Background

Early detection of prostate cancer (PCa) remains a controversial topic. Prostate-specific antigen (PSA)-based screening can reduce PCa mortality, but is debated due to the limited specificity of the test, which often results in overdiagnosis and overtreatment of clinically irrelevant PCa.

Objective

This review article presents the current evidence on PCa screening, with a particular focus on imaging diagnostics.

Results

The current German early detection program is based on digital rectal examination (DRE), but its specificity and sensitivity are insufficient. Instead of a structured program, Germany applies opportunistic PSA screening, which is not recommended due to an unfavorable benefit–risk ratio. Since 2022, the European Commission has called for organized, risk-adjusted screening programs that combine PSA tests with magnetic resonance imaging (MRI). MRI increases accuracy by better detection of clinically relevant PCa while simultaneously reducing overdiagnosis of low-risk tumors. An optimal PCa screening program should be personalized, systematically organized, and evidence based. In addition to PSA tests and MRI, genetic markers could also be integrated to further improve early detection.

Conclusion

An organized, risk-adjusted screening program that combines PSA testing with MRI could improve the benefit–risk ratio of PCa early detection. Key elements include population-wide invitations, adjustment to individual risk factors, and quality assurance in MRI.