How to cite: Bagrodia A. PSA: universal screening. Grand Rounds in Urology. November 2025. Accessed February 2026. https://grandroundsinurology.com/psa-universal-screening/
Summary
Aditya Bagrodia, MD, FACS, Professor of Urology and Radiation Oncology, University of California, San Diego, San Diego, California, reviews the history and current state of prostate-specific antigen (PSA)-based prostate cancer screening, explaining how early screening practices were implemented poorly and led to unintended consequences. Early screening practices led to over-screening in some populations, under-screening in others, and overtreatment of low-risk disease, while aggressive prostate cancer was sometimes missed. Despite these limitations, PSA screening was associated with a greater than 50 percent reduction in prostate cancer mortality, leading Dr. Bagrodia to emphasize that abandoning screening altogether was not the right solution.
Dr. Bagrodia discusses the downstream effects of the 2012 US Preventive Services Task Force Grade D recommendation against PSA screening, noting that this policy shift coincided with rising rates of metastatic prostate cancer and persistent racial disparities in outcomes. He explains that these trends were not solely the result of policy decisions, but also reflected failures within the medical community to apply screening appropriately and to align treatment strategies with disease risk.
In the presentation, Dr. Bagrodia introduces a framework for Smarter Screening and Smarter Treatment, centered on shared decision-making between clinicians and patients. He highlights the value of early baseline PSA testing and tailoring screening intensity based on individual risk factors such as race and family history. He stresses that referral to urology need not automatically imply a biopsy and that further risk assessment can often be performed in the primary care setting.
A major focus is on the use of multiparametric magnetic resonance imaging (MRI) prior to biopsy. Dr. Bagrodia explains how MRI can reduce unnecessary biopsies, avoid overdiagnosis of clinically insignificant disease, and improve detection of clinically significant prostate cancer. He concludes that thoughtful, risk-based PSA screening, integrated with modern imaging and high-quality treatment, offers the best path forward to improve outcomes while minimizing harm.
About the 32nd Annual Perspectives in Urology: Point Counterpoint conference: Presented by Program Chair and Grand Rounds in Urology Editor-in-Chief E. David Crawford, MD, this conference brought together leading experts in urology, medical oncology, and radiation oncology to discuss and debate the latest topics in genitourinary cancers, primarily prostate cancer and bladder cancer. This interactive conference offered topical lectures, pro/con debates, interesting-case presentations, interactive panel discussions, and interactive audience and faculty networking.
ABOUT THE AUTHOR
Aditya Bagrodia, MD, FACS, is a Professor of Urology and the Disease Team Co-Leader for Genitourinary Cancer at the University of California, San Diego. Dr. Bagrodia’s clinical and research interests on understanding molecular attributes of germ cell tumors, which cause testicular cancer, with the goal of ultimately improving treatments and clinical care. He also has been actively involved in understanding and overcoming societal and epidemiological barriers to optimal care in testicular cancer patients. He also has expertise in minimally invasive approaches to urologic surgery.
