Prostate cancer remains the most commonly diagnosed cancer in men and the second leading cause of cancer-related deaths after lung cancer, according to the American Cancer Society. Advances in screening and treatment have shifted care away from a one-size-fits-all model toward a more personalized approach, with the prostate-specific antigen (PSA) test at the center of this evolution.
The PSA blood test remains the most effective biomarker for detecting prostate cancer, particularly when the disease is still confined to the prostate. While early detection has significantly reduced mortality, experts caution that indiscriminate use of the test may lead to unnecessary treatment in men with low-risk cancers.
“Treating every prostate cancer patient the same can expose many to risks without meaningful benefit,” said Aditya Bagrodia, MD, professor of urology at UC San Diego School of Medicine and urologic oncologist at UC San Diego Health. “The focus now is on smarter screening and tailoring care to the individual.”
UC San Diego’s Smarter Screening Program
UC San Diego Health has developed a Smarter Screening Program designed to identify patients who require treatment while safely monitoring others through active surveillance. The program emphasizes shared decision-making, encouraging patients to work closely with their care teams—including primary care and geriatric specialists—when determining screening and treatment options.
Screening recommendations are divided into two age groups:
Ages 45–60: A baseline PSA test is advised. If the score is below 1, a follow-up may not be needed for five years. Scores between 1 and 2 typically require retesting within 6–12 months. Strong family histories of prostate, breast, endometrial cancer, or hematologic malignancies often prompt additional imaging, such as multi-parametric MRI.
Ages 61–75: The same PSA thresholds apply, though physicians are more likely to recommend MRI scans and specialist referrals for scores up to 3.
Next Steps After Abnormal Results
If PSA testing and MRI results suggest the likelihood of cancer, patients may undergo a biopsy. Modern techniques combine MRI with ultrasound to improve accuracy, and many procedures are now performed through the perineum rather than the rectum, reducing risks and complications.
Personalized Treatment Options
For patients requiring treatment, UC San Diego Health stresses individualized care. Many prostate cancers are slow-growing and do not require immediate intervention. Active surveillance is often recommended in such cases. For more aggressive cancers, treatment options are discussed within the framework of shared decision-making, ensuring patients understand both the risks and benefits of each choice.
“As oncologists, our goal is to identify the cancers that truly threaten life while sparing patients from overtreatment,” Bagrodia said. “A diagnosis does not automatically mean treatment is necessary.”
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