How to cite: Crawford ED. “History and Challenges of Early Detection of Prostate Cancer.” Grand Rounds in Urology. August 2026. Accessed Oct 2026. https://grandroundsinurology.com/history-and-challenges-of-early-detection-of-prostate-cancer/
Summary
In this presentation from the UroCancer Interdisciplinary Forum (UCIF) 2026, E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, San Diego, California, reviews the evolution of prostate cancer early detection, arguing that while prostate-specific antigen (PSA) screening has substantially reduced the burden of advanced disease, confusion surrounding its implementation has limited its full clinical benefit. Using the history of the Prostate Cancer Education Council as a framework, he describes how public awareness campaigns and community screening programs helped shift prostate cancer diagnosis from symptomatic metastatic disease toward earlier-stage detection.
Dr. Carwford explains that PSA itself is not the principal source of controversy. Instead, excessive biopsy rates, overtreatment of low-risk disease, inconsistent guideline recommendations, and complicated clinical pathways created uncertainty for both specialists and primary care physicians. He reviews the influence of several landmark screening studies, emphasizing that differences in study design complicated the interpretation of PSA screening outcomes.
A central focus of the presentation is the need for a practical screening strategy that primary care clinicians can implement. Dr. Crawford proposes using a PSA threshold of approximately 1.5 ng/mL as an early warning signal rather than an automatic indication for biopsy. Patients with elevated PSA should undergo repeat testing, clinical assessment, digital rectal examination, secondary biomarkers, magnetic resonance imaging, and individualized risk assessment before invasive evaluation. He stresses that PSA should function as the first step in a layered diagnostic pathway rather than as a stand-alone decision tool.
Looking ahead, Dr. Crawford discusses how biomarkers, imaging, genetics, and emerging artificial intelligence tools can improve risk stratification without increasing unnecessary intervention. He concludes that the future of prostate cancer screening depends on balancing early detection with appropriate risk assessment, simplifying clinical pathways for primary care, improving access to evaluation, and building systems that identify aggressive cancers while avoiding unnecessary diagnosis and treatment of indolent disease.
ABOUT THE AUTHOR
Researcher-physician E. David Crawford, MD, Jack A. Vickers Director of Prostate Research and Professor of Urology at the University of California, San Diego, San Diego, California, has devoted his career in medicine to educating the public about men's health issues and finding effective techniques and procedures to address prostate cancer, the most common malignancy affecting men in the United States.
