Beyond PSA: Jonathan Henderson, MD, on precision tools for prostate cancer

Among the CME offerings at the 2025 LUGPA Annual Meeting was a panel discussion titled “Adjuvant PSA [prostate-specific antigen] Biomarkers.” In this video, panelist Jonathan Henderson, MD, a urologist with Arkansas Urology in Little Rock, summarized some key takeaways from this program.

Henderson emphasized the evolving role of advanced biomarkers in refining prostate cancer risk assessment beyond traditional PSA testing. Although PSA remains a valuable first step in identifying potential prostate cancer, Henderson noted that it is far from perfect. To improve diagnostic accuracy and clinical decision-making, he discussed several adjunctive blood- and urine-based biomarkers—such as IsoPSA, 4Kscore, Prostate Health Index, ExoDx Prostate IntelliScore, and SelectMDx—that help determine the likelihood of clinically significant prostate cancer in patients with elevated PSA levels.

These biomarkers are particularly valuable in specific clinical scenarios: when patients have elevated PSA but are hesitant about undergoing a biopsy, when prior biopsies have been negative, or when MRI results are negative. Henderson highlighted that up to 30% of men with negative MRI scans may still harbor significant cancer, making supplemental testing crucial for risk stratification. He explained that these tests can either encourage a necessary biopsy in high-risk cases or provide reassurance when the probability of cancer is low, helping to avoid unnecessary procedures.

Looking ahead, Henderson noted growing interest in using these biomarkers for monitoring patients on active surveillance to detect disease progression, although he cautioned that this application is still under investigation. Ultimately, he described these tools as valuable additions to the clinician’s armamentarium—not universal tests for all patients, but precision tools to guide individualized care. Their greatest benefit, he concluded, lies in enhancing diagnostic confidence, optimizing patient selection for biopsy, and supporting shared decision-making between urologists and their patients.