General approaches to risk stratification in men with elevated PSA

Panelists discuss how risk stratification in men with elevated prostate-specific antigen (PSA) level remains one of the most critical challenges in urology, given that PSA levels alone are not always reliable indicators of clinically significant disease. They emphasize that traditional approaches often lead to unnecessary biopsies and patient anxiety. The availability of newer biomarkers, such as IsoPSA, Prostate Health Index (PHI), and 4Kscore, has provided clinicians with additional tools to refine patient selection and reduce overtreatment.

Panelists discuss how structure-based biomarkers, particularly IsoPSA, add unique value by measuring molecular changes in PSA rather than just concentration. This approach allows for better differentiation between indolent and aggressive prostate cancers. Other tests, such as PHI, SelectMDx, and Decipher, also contribute to a more nuanced understanding of patient risk, offering clinicians multiple pathways to tailor diagnostic strategies.

Panelists discuss how challenges remain in integrating these biomarkers into practice, including cost, access, and physician familiarity. However, the panel highlights that by combining biomarker data with patient history, demographics, and imaging, physicians can better inform shared decision-making and avoid unnecessary procedures. The consensus is that a multimodal approach holds the most promise for future prostate cancer care.