A Smarter Way to Screen for Prostate Cancer

For years, one of the biggest problems with prostate cancer screening has not been finding too little cancer.

It has been finding too much.

The standard PSA blood test can identify men who may need further testing, but an elevated PSA does not always mean cancer. It can also be caused by a benign enlarged prostate or other conditions.

That often leads to biopsies.

And biopsies can find very small, slow-growing cancers that may never have caused harm during a man’s lifetime.

That problem, known as overdiagnosis, has made doctors cautious about routine prostate cancer screening because treatment can bring side effects even when the cancer itself may never have become dangerous.

A large Swedish trial called GOTEBORG-2 suggests there may be a better way.

According to results published in the New England Journal of Medicine, researchers added an MRI scan between the PSA test and biopsy.

Men with an elevated PSA first received a prostate MRI.

Only those whose scans showed a suspicious area moved on to biopsy.

The approach reduced the number of biopsies by nearly 60% and halved the detection of low-risk cancers.

At the same time, researchers were still able to identify aggressive cancers that were more likely to need treatment.

That matters because the goal of prostate cancer screening is not simply to find as many cancers as possible.

It is to find the cancers that are most likely to threaten a patient’s health while avoiding unnecessary procedures and treatment for tumors that may never cause harm.

MRI screening is not perfect, and it does not remove every risk of overdiagnosis or missed cancer.

But the Swedish findings suggest it may help doctors better decide which men really need a biopsy after an elevated PSA result.

That could make prostate cancer screening more precise — and less likely to cause harm while trying to prevent it.