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

Welcome back to The UroOnc Minute!

In this episode of The UroOnc Minute, host Adam B. Weiner, MD, speaks with Badrinath R. Konety, MBBS, chief academic officer at Allina Health, president of the Allina Health Cancer Institute, and a panel member on the 2026 AUA/SUO Early Detection of Prostate Cancer Guideline amendment.¹ Recorded at the 2026 American Urological Association Annual Meeting in Washington, DC, the conversation highlights the rationale behind the updated guideline recommendations and explores how emerging evidence is reshaping prostate cancer screening and early detection.

Konety explains that the amendment was designed to incorporate evolving data while streamlining the guideline to better emphasize clinically meaningful recommendations. The discussion examines several key areas of change, including the growing role of pre-biopsy MRI, the continued importance of shared decision-making when determining prostate-specific antigen (PSA) screening intervals and when to discontinue screening, and the evidence supporting secondary biomarker testing in men with a prior negative biopsy. He also reviews the panel's approach to transperineal vs transrectal prostate biopsy, noting that although transperineal biopsy offers potential advantages in reducing infectious complications, the available evidence remains mixed and does not yet support a definitive recommendation favoring one approach over the other. The conversation also highlights commercially available secondary biomarkers, including the Prostate Health Index (PHI), 4Kscore, MyProstateScore, IsoPSA, and ExoDx Prostate, as tools that may help refine biopsy decisions in appropriately selected patients.

Looking ahead, Weiner and Konety discuss the practical challenges of implementing updated screening recommendations across large health systems, particularly through education of primary care clinicians and adherence to evidence-based guidance. They also consider future directions for prostate cancer screening, including broader adoption of biparametric MRI, incorporation of polygenic risk assessment, and continued refinement of biomarker-driven screening strategies. The episode concludes with a discussion of the evolving role of the digital rectal examination, reflecting the guideline's move away from emphasizing routine use while preserving physician discretion in individualized patient care.

REFERENCE

1. Lin DW, Carlsson S, Filson CP, et al. Updates to Early Detection of Prostate Cancer: AUA/SUO Guideline (2026). J Urol. 0(0).10.1097/JU.0000000000004995