Prostate cancer is identified by the authors as the second most common malignant tumor among men globally. Its early detection depends primarily on screening interventions. The review frames the core tension in screening policy: increasing the detection rate of clinically significant prostate cancer while avoiding overdiagnosis and overtreatment of low-risk tumors, and doing so in a way that considers economic value. That balance between benefit (finding cancers that matter) and harm (treating indolent disease) underpins current research and practice discussions.
According to the review, international screening strategies are evolving away from single-test approaches—most notably reliance on standalone prostate-specific antigen (PSA) testing—toward more personalized, risk-adapted frameworks. The field is exploring how to combine multiple assessment tools to stratify individual risk and thereby target further diagnostic workup and treatment. However, the authors note there is not yet a universally recognized, unified screening pathway adopted across countries or guidelines.
The review highlights several categories of stratification tools being evaluated to improve specificity and clinical relevance of screening. These include:
Magnetic resonance imaging (MRI), in particular multiparametric approaches, which are being integrated into diagnostic pathways to better identify lesions likely to be clinically significant.
Novel biomarkers beyond PSA, which may help distinguish aggressive from indolent disease and refine selection for imaging or biopsy.
Multivariable risk prediction models that combine clinical, laboratory, and imaging data to estimate an individual’s probability of harboring clinically important prostate cancer and guide subsequent management.
The review emphasizes that these tools are components of an emerging individualized strategy, but evidence has not yet converged on a single accepted approach.
The authors report that, in China, the incidence of prostate cancer has increased rapidly in recent years, yet the early diagnosis rate remains relatively low. This disparity is attributed directly to insufficient prevalence of prostate cancer screening in the population. The review identifies several specific barriers faced within China:
A lack of a reasonable, evidence-based screening model tailored to elderly high-risk populations.
Insufficient public awareness about prostate cancer screening and early detection.
Absence of a refined, standardized screening pathway that could guide consistent practice across communities and health services.
These constraints are presented as major limitations to improving early detection and reducing the burden of advanced disease.
To address the identified gaps, the authors argue for development of stratified screening strategies that are suitable for the Chinese population and grounded in Chinese data. Key priorities noted in the review include:
Using domestic epidemiologic and clinical data to design risk-adapted screening algorithms that reflect local disease patterns and resource considerations.
Promoting a transition from opportunistic screening—where testing occurs inconsistently or only in certain clinical interactions—to systematic screening programs that are organized and population-based.
Enhancing public education to raise awareness of prostate cancer and the potential benefits and harms of screening.
The review frames these tasks as necessary next steps to improve early diagnosis rates in China while managing overdiagnosis and economic impact.
This review was published in Beijing Da Xue Xue Bao Yi Xue Ban in 2026 (volume 58, issue 4, pages 686–691). The authors are affiliated with the Department of Urology, Beijing Hospital, and related gerontology and clinical research centers in Beijing. The paper is indexed with PMID 42493433 and PMCID PMC13402079. A digital object identifier is provided (10.19723/j.issn.1671-167X.2026.04.002). The article is written in Chinese with an English abstract. The authors declare no conflicts of interest.
The review summarizes international trends and the authors’ appraisal of the situation in China. Specific data points, comparative performance metrics, or quantitative outcomes of particular screening strategies are not detailed in the PubMed abstract; readers should consult the full text for study-level evidence, methodology, and referenced source data. The review’s recommendations focus on strategic priorities rather than prescriptive protocols, reflecting that no single, globally accepted screening pathway currently exists.
Keywords: prostate cancer, screening, PSA, MRI, biomarkers, risk stratification.