Prostate Cancer Awareness Month: Prostate cancer screening in 2026

Prostate cancer screening has undergone significant shifts over the past several decades as clinicians have sought to balance the benefits of detecting clinically significant disease with the risks of overdiagnosis and overtreatment. From the widespread adoption of prostate-specific antigen (PSA) testing to the more risk-adapted approach used today, advances in screening and diagnostic tools have continued to shape how urologists evaluate men for prostate cancer.

In recognition of Prostate Cancer Awareness Month this September, Shiv B. Patel, MD, of AAUrology, reflects on how prostate cancer screening has evolved from a one-size-fits-all approach to a more individualized strategy.

Urology Times: How has the approach to prostate cancer screening evolved over the years, and where do things stand in 2026?

Patel: Screening has really gone through a full arc over the past few decades. In the 1990s and 2000s, PSA testing became widespread and virtually every man over 50 was screened annually, which caught a lot of cancer but also led to overdiagnosis and overtreatment of low-risk disease that likely never would have caused harm. That pushed things too far in the other direction; the 2012 [United States Preventive Services Task Force] USPSTF recommendation against routine PSA screening led to fewer men being screened, and we started seeing more men present with advanced disease.

Since then, we've settled into a much more thoughtful, risk-adapted approach: shared decision-making, individualized starting ages and re-screening intervals based on a man's baseline PSA and risk factors, and better tools like mpMRI and reflex biomarkers to sort out who actually needs a biopsy. In fact, the AUA [American Urological Association] and SUO [Society of Urologic Oncology] just updated their Early Detection of Prostate Cancer guideline this year, reinforcing that direction with more personalized re-screening intervals, expanded biomarker guidance, and MRI before initial biopsy as a more standard step.¹ In 2026, we're not screening less than we were in the 1990s or more than we were in the early 2000s, we're screening smarter.

Related: The UroOnc Minute: AUA 2026 Update on Prostate Cancer Early Detection, With Badrinath R. Konety, MBBS

Urology Times: How can urologists and primary care physicians (PCPs) work together to make sure patients at higher risk—including those with a strong family history or genetic predisposition—are being identified and screened appropriately?

Patel: This really starts in primary care, since that's where most men have their first conversation about screening. Most PCPs ask about family history of prostate cancer at every annual visit, the same way they ask about family history of colon or breast cancer, and flag men with a first-degree relative diagnosed at a young age or a known BRCA2 or HOXB13 mutation as higher risk. Those men should be having the screening conversation earlier, often in their early-to-mid 40s rather than waiting until 50.

On our end, urologists need to make it easy for PCPs to refer for genetic counseling and testing when there's a strong family history, and to have a clear, fast pathway once a PCP flags an abnormal PSA. The best outcomes happen when primary care and urology are functioning as one team around a patient, not 2 separate systems he must navigate on his own.

Urology Times: Where do multiparametric MRI (mpMRI) and biomarkers fit into the current diagnostic pathway?

Patel: Both have become central to how we work up an elevated PSA. mpMRI is now typically the next step before a biopsy in most men. Imaging lets us see whether there's a suspicious lesion, target that area specifically if we do biopsy, and in some cases avoid an unnecessary biopsy altogether if the MRI is negative and the patient's risk is otherwise low.

Biomarkers add another layer of risk stratification, especially useful in borderline PSA, or to help decide whether a patient with a prior negative biopsy, or equivocal MRI, still needs a biopsy. Together, they let us be much more selective about who actually goes through a biopsy.

Urology Times: How should clinicians balance the benefits of earlier prostate cancer detection against concerns about overdiagnosis and overtreatment?

Patel: This is really the central tension in prostate cancer screening, and I don't think there's a way to fully eliminate it. The goal is to manage it in a balanced and thoughtful way. Earlier detection absolutely saves lives when it catches aggressive, clinically significant cancer while it's still curable. At the same time, we know a meaningful share of prostate cancers detected by PSA are low-risk and would never have caused a man harm in his lifetime, which is why active surveillance, not immediate treatment, is now the standard of care for most low-risk, Gleason 6 disease.

We manage that balance by being more selective on the front end by using risk-adapted screening intervals, mpMRI, and biomarkers to reduce unnecessary biopsies, and more selective on the back end, by not defaulting to surgery or radiation the moment we find cancer. Done appropriately, that combination lets us keep the benefit of early detection while meaningfully cutting down on overtreatment.

Urology Times: Where do you see the biggest gaps in access to prostate cancer screening and diagnostic evaluation, and what can urologists do to address them?

Patel: The biggest gaps I see are geographic and socioeconomic. Men in rural areas often don't have a urologist nearby, and getting an mpMRI or a biomarker test can mean travel, cost, or wait times that a lot of men don't have the flexibility for. We also see real disparities for African American men, who face both a higher incidence of prostate cancer and a higher risk of aggressive disease, but who are sometimes screened later or less consistently than their risk would warrant. Cost and insurance coverage for some of the newer biomarker tests and imaging can also be a barrier, even when they'd help avoid an unnecessary biopsy.

Urologists can help by partnering with primary care and community organizations on outreach and education, supporting community-based screening events, and pushing for policies and payer coverage that make these tools accessible to the patients who need them most, not just the ones who can easily get to a major medical center.

Urology Times: Looking ahead, what developments in biomarkers, imaging, genetics, or other technologies do you think have the potential to meaningfully change prostate cancer screening over the next several years?

Patel: It is genuinely exciting where this field is headed. On the biomarker side, we're seeing more refined blood and urine-based tests, and I think we'll keep getting better at combining them with clinical and genetic data to build a more complete risk profile for each patient, rather than leaning on PSA and history alone. Imaging has evolved tremendously as well. PSMA [prostate-specific membrane antigen]-PET is already changing how we stage advanced disease, and I expect AI-assisted MRI interpretation to make our targeting more accurate and more consistent across providers.

Genetics will keep playing a bigger role as well. I believe we'll see broader use of germline testing and, eventually, polygenic risk scores that help identify high-risk men well before their PSA ever becomes abnormal.

Put together, I think the next several years move us toward screening that's built around each man's individual risk profile from the start, rather than a one-size-fits-all approach.

Urology Times: Is there anything else that you’d like to add?

Patel: This month is about starting a conversation, not creating fear. Prostate cancer is common, but it's also one of the more treatable cancers when we catch it at the right time and manage it thoughtfully. If you're a man over 40 with a family history, or over 45 to 50 without one, talk to your doctor about what screening makes sense for you. And if you're the friend, partner, or family member of a man who's been putting that conversation off, this might be a good month to bring it up.

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