Rena Malik, MD Podcast Moment: Why Prostate Cancer Screening Is More Confusing Than Ever
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Mar 25, 2026 Scott Eggener, a leading prostate cancer surgeon and academic urologist, offers expert perspective on PSA screening and prostate cancer workups. He covers personalized screening timing and stopping rules. He discusses biomarkers and MRI trade-offs. He outlines modern biopsy approaches and how clinicians tell low-risk from potentially aggressive cancers.
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PSA Screening Saved Lives But Also Caused Harm
- PSA screening reduced age-adjusted prostate cancer deaths by roughly 50% in the U.S. population.
- Early indiscriminate screening also caused widespread overdiagnosis and overtreatment before risk stratification tools existed.
Start With A Baseline PSA And Individualize Frequency
- Get a baseline PSA between ages 40 and 55 and use risk factors plus that baseline to tailor screening intervals.
- Instead of yearly testing for everyone, return in 1, 2, or 4 years based on risk and PSA level.
Stop Age Is Flexible Not Fixed
- The guideline upper age (69) comes from trials enrolling 55–69 year olds where mortality benefit was shown.
- Screening can be appropriate in healthy men into their 70s or early 80s if life expectancy exceeds ~10–15 years.