Prostate cancer screening : Toward a sequential and multimodal approach ?

Prostate cancer, the most common cancer among men in many Western countries, is associated with variable mortality depending on its initial aggressiveness. Historically, detection has relied on digital rectal examination and prostate-specific antigen (PSA) testing. When used alone, PSA enables earlier detection and may reduce disease-specific mortality according to some studies, but at the cost of significant overdiagnosis and overtreatment. In this context, French and international guidelines have converged toward an individualized approach to PSA testing, based on patient information and risk assessment.

Over the past fifteen years, initial data from randomized screening trials have been updated, while new blood biomarkers and risk calculators have emerged. In addition, prostate MRI is now routinely used to guide biopsy decisions, particularly targeted biopsies for detecting clinically significant disease. For clinically insignificant cancers, active surveillance has become widely adopted in order to reduce overtreatment.

These developments pave the way for detection and screening strategies based on a sequential and multimodal approach, aiming to reduce unnecessary biopsies while maintaining early detection of aggressive cancers and promoting surveillance for low-risk disease. This approach requires multidisciplinary coordination and rigorous evaluation to ensure integration into a coherent and acceptable public health policy.