# New Tools for Detecting Prostate Cancer Early: A Patient's Guide to Emerging Screening Technologies Prostate cancer is the second most common cancer in men worldwide. Today's screening relies mainly on a blood test called prostate-specific antigen (PSA). This test often flags slow-growing tumours that would never cause harm. A new review of the evidence finds that MRI imaging can find dangerous cancers while cutting unnecessary biopsies. This includes faster, cheaper versions such as biparametric MRI. Blood tests, urine tests and saliva-based genetic risk scores can help doctors decide who needs imaging or a biopsy in the first place. Large randomised trials are still urgently needed before these tools can replace or supplement PSA for population-wide screening. # Emerging tools for the early detection of prostate cancer ## Table of Contents - Key Points - Background: Why Finding Prostate Cancer Early Is Complicated - How This Review Was Conducted - The Problem With PSA Testing - MRI Imaging: The Current Gold Standard - Biparametric MRI: A Faster, Contrast-Free Alternative - Ultra-Short MRI Protocols - MRI for Population-Wide Screening - Ultrasound-Based Approaches - Blood-Based Biomarker Tests - Urine-Based Biomarker Tests - Saliva-Based Genetic Risk Scores - What This Means for Patients - Limitations of the Evidence - Practical Recommendations - Frequently Asked Questions - Source Information ## Key Points - PSA is organ-specific but not cancer-specific; only about one in three men with an elevated PSA actually has cancer found on initial assessment. - In the PRECISION trial, adding MRI before biopsy increased detection of clinically significant cancer by 12% and reduced biopsies by 28%. - In the PRIME trial of 490 men, biparametric MRI detected clinically significant cancer in 28.8% versus 29.2% for multiparametric MRI, with similar biopsy rates. - For low-risk Gleason 6 disease (PSA under 10 ng/mL, stage T2a or lower), the risk of dying from prostate cancer over 10 to 15 years without treatment is less than 3%. - In the ReIMAGINE trial, 60% of men with clinically significant cancer had a PSA below 3 ng/mL, so PSA alone would have missed them. ## Background: Why Finding Prostate Cancer Early Is Complicated Prostate cancer (PCa) is the second most common cancer in men globally. In 2020, roughly **1.4 million men** were diagnosed with prostate cancer worldwide, and that number is projected to reach **2.9 million by 2040** — driven by longer life expectancy and population growth. Prostate cancer is the **fifth leading cause of cancer-related death** globally, and most of those deaths come from late diagnosis. When the disease is caught at an early stage, cure rates with radical treatment (surgery or radiation) are excellent. The challenge is that early detection is not straightforward. The main screening tool is the prostate-specific antigen test (PSA). PSA is a protein made by the prostate gland that leaks into the blood when the prostate is enlarged or diseased. The PSA test is organ-specific but not cancer-specific. That means it can be elevated for reasons other than cancer, including benign prostatic hyperplasia (BPH, an enlarged but non-cancerous prostate) and prostatitis (inflammation of the prostate). The consequence is a large number of false alarms. **Only about one in three men with an elevated PSA will actually have cancer** found on initial assessment. And among those who do turn out to have cancer, the majority — **69.4%** — are diagnosed with localised disease, of which roughly half are clinically insignificant (Gleason score ≤6). The Gleason score is a grading system that describes how abnormal the cancer cells look under a microscope. A score of 6 or below marks a low-grade tumour that grows very slowly. For men with Gleason ≤6 tumours classified as low risk (PSA under 10 ng/mL and stage ≤T2a), the risk of dying from prostate cancer over 10 to 15 years — even without any treatment — is **less than 3%**. In other words, the risks of treating these cancers often outweigh the benefits. Earlier PSA screening trials produced mixed results, partly because of how they were designed. The PLCO cancer screening trial in the United States failed to show any benefit from organised annual PSA testing. But the control group was heavily contaminated. Men in the control group averaged 2.7 PSA tests versus 5 in the screening group, and many had testing outside the trial. The ERSPC trial (European Randomised Study of Screening for Prostate Cancer) showed a **20% reduction in prostate cancer deaths** after a 16-year follow-up — equating to **18 diagnoses needed to prevent one death**. However, it also came with a large number of unnecessary biopsies: only **24% of biopsies** led to a prostate cancer diagnosis. A large UK study, the CAP trial, found that a one-off PSA screening raised the number of diagnoses compared with the control group (**4.3% versus 3.6%**), yet produced no statistically significant difference in prostate cancer death rates (rate ratio **0.96**, 95% confidence interval 0.85 to 1.08) after a median follow-up of 10 years. Because the benefits do not clearly outweigh the harms, the US Preventive Services Task Force (USPSTF) advises against population-wide screening. Instead it recommends a shared decision-making process for men aged **55 to 69**, in which the patient and clinician weigh the risks and benefits together. ## How This Review Was Conducted This is a narrative review, not a new clinical trial. The authors identified and evaluated key published articles on emerging adjuncts and alternatives to PSA for early prostate cancer detection. They examined two broad categories of tools: new imaging strategies and molecular biomarker tests, including blood-based, urine-based and saliva-based tests. Their goal was to assess whether these tools could deliver something PSA cannot. That is a cost-effective test with high sensitivity (the ability to correctly identify men who do have cancer) and high specificity (the ability to correctly identify men who do not). The goal was also to minimise the overdiagnosis of harmless tumours. ## The Problem With PSA Testing PSA (encoded by a gene called KLK3) is a serine protease glycoprotein — a protein enzyme that liquefies the seminal coagulum, the gel-like substance in semen. It is a useful organ marker, but it cannot tell the difference between a harmless enlarged prostate and a dangerous tumour. This single limitation drives most of the controversy around prostate cancer screening. Overdiagnosis — finding cancers that would never have caused symptoms — leads directly to overtreatment, which can bring side effects such as incontinence and erectile dysfunction. The search for better tools is therefore driven by one goal: find the dangerous cancers, and leave the harmless ones alone. ## MRI Imaging: The Current Gold Standard Multiparametric MRI (mpMRI) of the prostate is currently the gold standard for identifying clinically significant prostate cancer (csPCa, cancer that is likely to grow and spread and needs treatment). MRI combines several imaging sequences: anatomical images (T1- and T2-weighted) plus functional sequences. The functional sequences include dynamic contrast-enhanced imaging (DCE, where a dye is injected to show blood flow). They also include diffusion-weighted imaging (DWI, which measures how freely water molecules move through tissue). Current European Association of Urology (EAU) guidelines strongly recommend mpMRI before biopsy, using the Prostate Imaging Reporting and Data System (PI-RADS) scoring system to grade suspicious areas from 1 to 5. In the UK, the National Institute for Health and Care Excellence (NICE) recommends a similar system called Likert scoring. Three landmark trials cemented the role of mpMRI before biopsy: - **PROMIS** showed that mpMRI before biopsy could reduce the need for biopsy in **27% of patients** compared with PSA alone, and reduced the diagnosis of clinically insignificant prostate cancer. - **PRECISION** demonstrated that mpMRI-guided biopsy was non-inferior to standard transrectal ultrasound (TRUS)-guided biopsy, producing a **12% increase** in csPCa detection (p=0.005) while reducing the number of biopsies by **28%**. - **MRI-FIRST** showed that combining systematic and targeted biopsies detected more clinically significant cancers than either technique alone. Put simply, MRI improves the accuracy of biopsies and helps many men avoid an unnecessary procedure. ## Biparametric MRI: A Faster, Contrast-Free Alternative Biparametric MRI (bpMRI) removes the need for gadolinium contrast dye. This eliminates the dynamic contrast-enhanced (DCE) sequence, saving both time and money. Because no intravenous line or contrast agent is needed, bpMRI is simpler to perform and easier to scale for screening programmes. The PRIME trial — a large, multi-centre study of **490 men** — compared bpMRI with mpMRI for detecting clinically significant prostate cancer, and results were presented at the EAU 2024 meeting. The proportion of patients who needed a biopsy was similar: **273 out of 490 (56%) for bpMRI** versus **279 out of 490 (57%) for mpMRI**. Detection rates were also nearly identical. bpMRI was non-inferior to mpMRI for finding clinically significant disease (Gleason ≥3+4), with only a **0.4% lower detection rate**: **143 out of 490 (29.2%) for mpMRI** versus **141 out of 490 (28.8%) for bpMRI** (p=0.5). Sensitivity was **99.3%** for mpMRI and **97.9%** for bpMRI. Specificity was **59.9%** for mpMRI and **61.1%** for bpMRI. In plain terms, the two methods performed essentially the same. One important detail concerns image quality. PRIME only included high-quality MRIs, meaning only centres with an MRI quality score of 4 or 5 on the Prostate Imaging Quality (PI-QUAL) scale were selected. In Phase I, only **23 out of 71 scanners (32.4%)** initially achieved a PI-QUAL score of 5. After targeted improvements to MRI protocols — adjusting image resolution, contrast timing and sequence parameters — **62 out of 64 scanners (96.9%)** achieved a score of 5 in Phase II. This shows that systematic evaluation and protocol optimisation can substantially enhance MRI quality. The IP7-PACIFIC trial is currently underway as a definitive study of the clinical utility and health economics of bpMRI versus mpMRI, and of visual registration versus image-guided fusion biopsy. ## Ultra-Short MRI Protocols For population-wide screening, the cost of MRI becomes a real limitation. Shorter protocols would improve access and reduce costs. A Dutch study compared three approaches: standard mpMRI, triplanar noncontrast MRI (standard bpMRI), and a fast monoplanar noncontrast MRI (fast bpMRI). All three protocols achieved **95% sensitivity** for detecting high-grade prostate cancer. The fast bpMRI slightly reduced specificity (**65% versus 69%**) and led to a marginal increase in unnecessary biopsies and low-grade cancer detection. Scan times differed significantly: - **mpMRI**: 16 minutes - **bpMRI**: 13 minutes - **Fast bpMRI**: 8 minutes The trade-off is clear: faster scans mean slight reductions in accuracy but potentially much wider access. ## MRI for Population-Wide Screening Current EAU guidelines advise against using MRI for prostate cancer screening. Yet emerging evidence suggests MRI-based imaging could be an alternative to PSA-based screening. The EAU is collaborating with the European Union on the PRAISE-U project. This project aims to reduce prostate cancer illness and death by developing better screening strategies, including combining PSA and MRI. The Göteborg2 study, involving **17,980 men**, showed that MRI screening could reduce overdiagnosis of insignificant prostate cancer by half. Men with raised PSA (≥3 ng/mL) were divided into two groups. The reference group underwent systematic and targeted biopsies; the experimental group underwent MRI-targeted biopsies only. In the experimental group, the risk of overdiagnosing clinically insignificant prostate cancer was halved compared with the reference group (**0.6% versus 1.2%; relative risk 0.46; 95% CI 0.33 to 0.64; P<0.001**). But this came at the cost of missing some clinically significant cancers (**0.9% versus 1.1%; relative risk 0.81; 95% CI 0.60 to 1.1**). Reassuringly, in the reference group, all 10 clinically significant cancers detected by systematic biopsy alone were classified as intermediate risk and managed with active surveillance (close monitoring rather than immediate treatment). One limitation: the negative predictive value (how reliably a negative scan rules out cancer) was not evaluated in the experimental group. Men with PI-RADS 1–2 findings did not receive a biopsy, and there was no extended follow-up for these men. A large systematic review and meta-analysis covering more than **80,000 men across 12 studies** found that integrating MRI into prostate cancer screening pathways reduces unnecessary biopsies and overdiagnosis of insignificant disease, while maintaining detection rates of clinically significant cancer compared with PSA-only screening. Several other trials have tested MRI screening directly: - **MVP trial (Canada)**: bpMRI-only screening was compared with PSA. bpMRI had a cancer detection rate of **63% (15 out of 24)** versus **29% (8 out of 23)** for PSA alone (p=0.019). bpMRI also detected more clinically significant cancers (**73% versus 50%**), with a relative risk of **2.77 (95% CI 0.89 to 8.59, p=0.07)**. - **ReIMAGINE trial**: using bpMRI (T2-weighted plus diffusion-weighted sequences) for screening, **303 men** underwent MRI. Of these, **48 men (16%)** had a positive MRI, and of those, **25 (52%)** had clinically significant cancer. Only **2 (4%)** had clinically insignificant cancer. Notably, two thirds of men with a positive MRI and **60% of men who had clinically significant cancer** had a PSA under 3 ng/mL — meaning PSA alone would have missed them. - **IP-1 PROSTAGRAM study (N=408)**: compared PSA, bpMRI, and ultrasound (b-mode plus shear wave elastography). Abnormal results were found in **40 patients (9.9%; 95% CI 7.3%–13.2%)** for PSA, **43 (10.6%; 95% CI 7.9%–14.0%)** for bpMRI, and **52 (12.8%; 95% CI 9.9%–16.5%)** for ultrasound. Using these cutoffs, bpMRI detected the most clinically significant cancers (**11**), followed by PSA (**7**) and ultrasound (**4**). - **VISIONING trial (Switzerland)**: investigated bpMRI as primary opportunistic screening without using a PSA cutoff. Among **229 participants**, **21** were found to have clinically significant cancer — a detection rate of about **1 in every 11 bpMRI scans**. The median PSA value in the cohort was only **1.26 ng/mL**. A protocol adjustment deferring biopsies for PI-RADS 3 lesions unless they showed persistence or upgrading reduced unnecessary biopsies. MRI-based screening has real limitations, including interobserver variability (different radiologists reading scans differently) and cost. A UK-based study is testing luminal index MRI (LI-MRI) for community screening, which offers shorter scan times of **5 minutes** and lower costs. The PRAISE-U project also conducted a systematic review of the cost-effectiveness of prostate cancer screening in Europe. Screening studies involving initially healthy populations found a median incremental cost-effectiveness ratio (ICER — the extra cost per unit of health gained) of **€56,487 per quality-adjusted life year (QALY)**, ranging from **€5,872 to €372,948 per QALY**. Risk-based screening strategies incorporating MRI were more cost-effective than no screening. MRI may also not be the best tool for younger men. The PROBASE trial evaluated risk-adapted screening based on baseline PSA rather than imaging alone. The PROBASE trial highlighted the limits of mpMRI for detecting cancer in younger men. Interpreting MRIs in younger patients is more complex because of normal age-related tissue changes. ## Ultrasound-Based Approaches Multiparametric ultrasound (mpUS) combines contrast-enhanced ultrasound (CEUS), micro-Doppler, and real-time elastography. Currently there is no universally accepted standardised scoring system for mpUS in prostate cancer detection — a key barrier to wide adoption. The CAMDUS study (Cancer Diagnosis by Multiparametric Ultrasound of the Prostate) is one effort to address this. High-resolution micro-ultrasound is being tested in several major randomised trials, including: - **MUSIC-Screen**: a Phase 3, multicentre, international, non-inferiority randomised trial comparing prostate cancer screening using high-resolution micro-ultrasound versus mpMRI. - **OPTIMUM**: a 3-arm randomised controlled trial evaluating the role of 29 MHz micro-ultrasound in guiding prostate biopsy in men with clinical suspicion of prostate cancer. A systematic review found that micro-ultrasound reduced detection of clinically insignificant cancers to **62 cases** compared with **115 cases** for systematic biopsies (detection ratio **0.55**, 95% CI 0.41–0.73, with very low inconsistency between studies, I² = 0%). These findings were corroborated in the first multicentre prospective trial comparing micro-US and mpMRI targeted biopsies: micro-US-guided biopsies were non-inferior for detecting clinically significant cancer. ## Blood-Based Biomarker Tests Blood-based biomarker tests can improve risk stratification — reducing unnecessary biopsies while maintaining detection of clinically significant cancers compared with PSA alone. The review highlights three that have been studied most extensively: - **Stockholm3 (STHLM3)**: combines **five protein markers** (human glandular kallikrein 2, microseminoprotein beta, microphage inhibitory cytokine-1, total PSA and free PSA) with **101 single nucleotide polymorphisms (SNPs, small genetic variations)**, plus clinical data on age, family history and previous prostate biopsy. It is intended for men aged **45 to 74** with no previous prostate cancer diagnosis and a PSA of **≥1.5**. - **4Kscore**: measures **four prostate-specific kallikreins** (total PSA, free PSA, intact PSA, and human kallikrein 2), combined with age, digital rectal exam (DRE) findings, and prior biopsy history. It is intended for men aged **45 and older** with an abnormal PSA or DRE before a first biopsy, or after a negative biopsy. - **Prostate Health Index (PHI)**: uses **three kallikrein assays** (PSA, free PSA and [-2]proPSA). It is intended for men aged **50 and older** with a PSA between **2 and 10** and a negative DRE. ## Urine-Based Biomarker Tests Urine-based biomarker tests have been examined for early detection and risk stratification of clinically significant disease as adjuncts to PSA testing. Three are highlighted: - **ExoDx**: measures exosomal RNA expression of three genes — *ERG*, *PCA3* and *SPDEF*. It is intended for men aged **50 and older** with a PSA between **2 and 10**, for either a first or repeat biopsy. - **My Prostate Score (MPS)**: combines urinary PCA3 and TMPRSS2:ERG (measured after a digital rectal exam) with serum PSA. It estimates the risk of a Gleason Grade ≥2 tumour on biopsy. - **SelectMDx**: measures mRNA expression of *DLX1* (Distal-Less Homeobox 1) and *HOXC6* (Homeobox protein Hox-C6), after a digital rectal exam, alongside age, DRE findings, PSA and prostate volume. It estimates the risk of any prostate cancer and of Gleason score ≥7 on biopsy. ## Saliva-Based Genetic Risk Scores Saliva-derived polygenic risk scores (PRS) combine the effects of many common genetic variants into a single risk number. Saliva-derived polygenic risk scores hold potential as a non-invasive screening tool to identify at-risk patient groups. Alongside biomarker tests such as the Stockholm3, PRS are being studied in trials including **BARCODE1** (Biomarker for Risk of Prostate Cancer: 1st Study) and **PROFILE** (Germline Genetic Profiling: Correlation with Targeted Prostate Cancer Screening and Treatment). The logic is straightforward: rather than screening every man with the same test, use genetic and molecular risk scores to focus imaging-based early detection on men at highest risk. ## What This Means for Patients The review makes several points that matter directly to men considering prostate cancer screening. First, PSA testing as currently performed finds a lot of cancers that do not need treatment. Only about one in three men with an elevated PSA actually has cancer. In many of the men diagnosed, the tumours are low risk. These tumours have less than a 3% chance of causing death over 10 to 15 years even without treatment. Second, MRI has already transformed diagnosis by reducing unnecessary biopsies and detecting more clinically significant cancers. In the PRECISION trial, adding MRI to the biopsy pathway increased detection of clinically significant cancer by 12% and reduced biopsies by 28%. Third, newer imaging options — bpMRI and potentially micro-ultrasound — appear to offer similar accuracy to standard mpMRI at lower cost. The PRIME trial showed essentially identical detection rates between bpMRI and mpMRI (29.2% versus 28.8%), and the fast bpMRI protocol takes only 8 minutes versus 16 minutes for the standard version. Fourth, MRI screening can detect cancers that PSA misses. In the ReIMAGINE trial, 60% of men who had clinically significant cancer had a PSA below 3 ng/mL — meaning PSA alone would have missed them entirely. Fifth, molecular biomarkers and genetic risk scores could help target who needs imaging in the first place, potentially making screening programmes more cost-effective. The PRAISE-U review found MRI-based risk-stratified screening more cost-effective than no screening. ## Limitations of the Evidence The review is careful to note where the evidence falls short. These are important caveats for anyone reading headlines about new screening tools. - **No long-term outcome data yet.** Most studies of MRI-based screening measure cancer detection, not whether fewer men die. Only longer follow-up will tell us whether these tools save lives. - **Randomised trials are still needed.** The authors state clearly that prospective randomised clinical trials are urgently needed to evaluate how different modalities perform in population-wide screening. Currently most comparisons rely on non-randomised or single-centre data. - **MRI has inherent limitations.** Interobserver variability (different radiologists disagreeing) and cost remain barriers to widespread screening use. - **Negative predictive value is not fully established.** In the Göteborg2 study, the researchers could not evaluate how reliably a negative MRI rules out cancer. Men with PI-RADS 1–2 findings did not receive biopsies and lacked extended follow-up. - **Age matters.** The PROBASE trial showed that MRI may not perform as well in younger men, because normal age-related changes make images harder to interpret. - **MRI-quality variability.** In the PRIME trial, only 32.4% of scanners initially achieved the highest quality score. Results may not be reproducible at centres without rigorous quality control. - **No standardised scoring for ultrasound.** There is currently no universally accepted scoring system for mpUS, limiting its comparability across studies. ## Practical Recommendations 1. **Discuss PSA screening with your clinician.** The USPSTF recommends a shared decision-making conversation for men aged 55 to 69 — weighing risks and benefits together. There is no single right answer for everyone. 1. **Know what a raised PSA means — and doesn't mean.** Only about 1 in 3 men with an elevated PSA will turn out to have cancer at first assessment. Repeat testing, additional blood tests such as PHI, 4Kscore or Stockholm3, or an MRI can clarify the picture before biopsy. 1. **Ask about MRI before biopsy.** International guidelines strongly recommend MRI before prostate biopsy. It has been shown to detect more clinically significant cancers while reducing the number of unnecessary biopsies by about a quarter. 1. **Understand your Gleason score.** If you are diagnosed with Gleason ≤6 disease, low risk (PSA under 10 ng/mL and stage ≤T2a), ask about active surveillance rather than immediate treatment. Over 10–15 years, the risk of dying from such cancer is less than 3% even without treatment. 1. **Ask about newer biomarker tests if your PSA is borderline.** Tests such as 4Kscore, Stockholm3, PHI, SelectMDx, ExoDx or MyProstateScore may help refine your risk estimate and avoid an unnecessary biopsy. 1. **Watch for ongoing trial results.** Major trials including MUSIC-Screen, OPTIMUM, IP7-PACIFIC and PRAISE-U will provide stronger evidence about which screening strategies work best. Ask your clinician whether participating in a trial is appropriate for you. Looking to the future, the authors note that new technologies — particularly artificial intelligence and diagnostic tests that incorporate circulating tumour markers — may further reshape how prostate cancer is detected early. ## Frequently Asked Questions ### What does an elevated PSA result actually mean? PSA is made by the prostate and can rise for reasons other than cancer, including an enlarged non-cancerous prostate or prostate inflammation. Only about one in three men with an elevated PSA will actually have cancer found on initial assessment. A raised result is therefore a prompt for further discussion, not a diagnosis, and repeat testing or additional tests can clarify the picture. ### Why is MRI recommended before a prostate biopsy? International guidelines strongly recommend MRI before biopsy. In the PRECISION trial, adding MRI to the biopsy pathway increased detection of clinically significant cancer by 12% and reduced the number of biopsies by 28%. The PROMIS trial found MRI before biopsy could reduce the need for biopsy in 27% of patients compared with PSA alone, while reducing diagnosis of insignificant cancers. ### What is biparametric MRI, and how does it compare with standard MRI? Biparametric MRI removes the need for gadolinium contrast dye, so no intravenous line is required, saving time and money. In the PRIME trial of 490 men, detection of clinically significant cancer was nearly identical: 29.2% for standard multiparametric MRI versus 28.8% for biparametric MRI. The proportion needing biopsy was also similar, 57% versus 56%. ### If I am diagnosed with Gleason 6 prostate cancer, do I need treatment straight away? For men with Gleason 6 tumours classified as low risk, the risk of dying from prostate cancer over 10 to 15 years is less than 3%. Low risk means PSA under 10 ng/mL and stage T2a or lower. This is true even without any treatment. The article suggests asking about active surveillance, which means close monitoring rather than immediate treatment, because the risks of treating these cancers often outweigh the benefits. ### Can MRI screening find cancers that a PSA test would miss? In the ReIMAGINE trial, 303 men had biparametric MRI screening. Of the men found to have clinically significant cancer, 60% had a PSA below 3 ng/mL, meaning PSA alone would have missed them. This suggests MRI-based screening can detect some cancers that PSA testing does not flag, though longer follow-up is needed to show whether this saves lives. ### What are the main limitations of using MRI for prostate cancer screening? MRI has real limitations. Different radiologists can read scans differently, and cost remains a barrier. In the PRIME trial, only 32.4% of scanners initially reached the highest quality score, so results may not be reproducible without rigorous quality control. Also, in the Göteborg2 study, how reliably a negative MRI rules out cancer could not be fully evaluated. ### Are there blood or urine tests that can help avoid an unnecessary biopsy? Several blood tests are intended to refine risk estimates in men with borderline PSA results. These include Stockholm3, 4Kscore and the Prostate Health Index. Urine tests such as ExoDx, My Prostate Score and SelectMDx are also intended to refine risk estimates in men with borderline PSA results. They may help reduce unnecessary biopsies while maintaining detection of clinically significant cancers compared with PSA alone. Ask your clinician whether any are appropriate for you. ### If my PSA is elevated but my biopsy is recommended, when should I get a second opinion before going ahead? An elevated PSA does not mean cancer: only about one in three men with a raised PSA have cancer found at first assessment. Before proceeding to biopsy, a second opinion can review whether repeat testing, additional blood tests such as PHI, 4Kscore or Stockholm3, or an MRI should come first. Guidelines strongly recommend MRI before biopsy, since it detects more clinically significant cancers while reducing unnecessary biopsies by roughly a quarter. A review of your PSA history, prior imaging and pathology can clarify whether biopsy is truly needed. Diagnostic Detectives Network provides independent expert second opinions. ## Source Information **Original article title:** Emerging tools for the early detection of prostate cancer **Authors:** Muhammad Haider, Jeffrey J. Leow, Tobias Nordström, Ashkan Mortezavi, Peter Albers, Rakesh Heer, and Prabhakar Rajan **Author affiliations:** Barts Cancer Institute, Queen Mary University of London, UK; Barts Health NHS Trust, London, UK; University College London Hospitals NHS Foundation Trust, London, UK; Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Danderyds Sjukhus and Karolinska Institutet, Stockholm, Sweden; University Hospital Zürich, Switzerland; University Hospital Düsseldorf and German Cancer Research Center, Heidelberg, Germany; Imperial College and Imperial College Healthcare NHS Trust, London, UK **Publication details:** BJUI Compass, 2025; 6: e70081. Published by John Wiley & Sons Ltd on behalf of BJU International Company. Open access under a Creative Commons Attribution License. DOI: 10.1002/bco2.70081. Received 9 April 2025; Accepted 23 August 2025. **Note:** This patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and should not replace personalised medical advice. Please consult your clinician about your individual screening options. --- Publisher: Diagnostic Detectives Network (https://diagnosticdetectives.com) — independent multi-expert medical second opinions, worldwide, private-pay. Author byline: Anton Titov, MD, PhD. Contact: https://diagnosticdetectives.com/pages/contact Canonical page: https://diagnosticdetectives.com/products/new-tools-for-detecting-prostate-cancer-early-a-patients-guide-to-emerging-screening-technologies