Prostate cancer screening.

Objective: To examine the current status and future perspectives of prostate cancer (PCa) screening. Methods: We conducted a narrative review of randomized controlled trials focused on PCa screening and treatment. This review specifically focused on population-based trials enrolling men at average risk of PCa. Results: Prostate-specific antigen has been the cornerstone of PCa screening since its clinical introduction in the late 1980s. Four contemporary high-quality randomized controlled trials assessed the efficacy of a prostate-specific antigen-based screening program on PCa mortality. We address conflicting results and differences among these trials. In recent years, MRI has gained significance, particularly in the targeted diagnostic pathway of PCa. Four randomized controlled trials and one cohort study have evaluated its use in PCa screening programs. Additionally, three pivotal trials have investigated the impact of radical PCa treatment on mortality, indirectly evaluating the utility of screening protocols. Current positions of major society guidelines are also addressed. Risk-adapted strategies, considering combined factors, are envisioned as the future towards precision medicine. Conclusion: PCa screening has demonstrated a benefit in terms of reducing PCa mortality after 10 years of follow-up. Nevertheless, its application is not without risks, so a shared decision-making process must be ensured between the patient and the clinician. Emerging tools such as MRI, genetic panels, and new biomarkers show promising opportunities to reduce these harms and the overdiagnosis of low-risk cancers. An individualized approach for each patient, based on detected risks and clinical parameters, helps guide different clinical pathways.