New Advances in Prostate Cancer Detection and Management

Recent key publications

Artificial intelligence-assisted prostate cancer diagnosis for reduced use of immunohistochemistry. 
Commun Med (Lond). 2025 Oct 15;5(1):425. doi: 10.1038/s43856-025-01185-y. Blilie A, Mulliqi N, Ji X et al.

 Link to full article:https://pubmed.ncbi.nlm.nih.gov/41094148/

Immunohistochemistry (IHC) is still routinely used to resolve ambiguous prostate biopsies, adding both cost and delay even as pathology departments move toward digital workflows. In this retrospective study spanning three European centres, researchers tested a task specific AI model on standard H&E slides that had previously required basal cell IHC for clarification. The model achieved area under the curve values up to 0.993, and when sensitivity prioritised thresholds were applied, no false negatives occurred. Overall IHC use dropped by 20 to 44%, with reductions reaching as high as 81% among benign cases. Given growing pressure on laboratory budgets and the expansion of digital pathology, these results point to a practical way to streamline diagnostic workflows while preserving patient safety.

Finding Holes: Pathologist-Level Performance Using AI for Cribriform Morphology Detection in Prostate Cancer. 
Eur Urol Open Sci. 2026 Apr 7:87:31-39. doi: 10.1016/j.euros.2026.03.016. eCollection 2026 May. Szolnoky K, Blilie A, Mulliqi N et al.

 Link to full article:https://pubmed.ncbi.nlm.nih.gov/42004835/

Cribriform morphology defines a lethal prostate cancer phenotype that excludes patients from active surveillance yet remains underreported due to substantial interobserver variability. This study presents the first comprehensively validated artificial intelligence system for automated cribriform detection across multiple international cohorts and scanner platforms. The model achieved an area under the curve of 0.97 internally and 0.90 externally, and in head-to-head comparison against nine expert uropathologists, the algorithm showed the highest mean pairwise agreement. As the 2024 European Association of Urology guidelines increasingly emphasise cribriform pattern reporting, this approach offers a scalable solution to standardise risk stratification and improve treatment decisions.

Polygenic risk scores for premagnetic resonance imaging risk stratification in men with clinically suspected prostate cancer. 
J Natl Cancer Inst. 2026 Jun 1;118(6):1063-1072. doi: 10.1093/jnci/djag027. Fischer MP, Mayer A, Braun A et al.

 Link to full article:https://pubmed.ncbi.nlm.nih.gov/41629765/

Roughly half of men with elevated prostate specific antigen levels end up with a negative MRI scan, consuming resources without offering any real clinical benefit. This prospective study followed 386 men of Western European descent to see whether polygenic risk scores could help refine triage decisions before imaging. The prostate cancer polygenic risk score showed a significant association with positive MRI findings, with an odds ratio of 1.56, while PSA alone did not. When age was combined with the polygenic risk score, the proportion of men showing suspicious findings rose from 46% to 60% compared with PSA based selection alone. Building on the recent BARCODE1 trial, which highlighted the value of polygenic risk scores in screening, this study extends that approach to the diagnostic MRI pathway.

Targeted Prostate Cancer Screening in Carriers of BRCA1 or BRCA2 Pathogenic Germline Variants Detects Clinically Relevant Disease: 5-year Results from the IMPACT Study. 
Eur Urol. 2026 May;89(5):457-468. doi: 10.1016/j.eururo.2026.01.031. Epub 2026 Feb 18. Bancroft EK, Page EC, McHugh J et al.

 Link to full article:https://pubmed.ncbi.nlm.nih.gov/41714267/

Whether men carrying germline BRCA1 pathogenic variants benefit from prostate specific antigen screening has remained an open question, even though BRCA2 carriers already have established screening recommendations. The prospective IMPACT study now offers evidence on this point, following 3063 men aged 40 to 69 through five annual screening rounds. Among BRCA2 carriers, the incidence of clinically significant prostate cancer was notably higher than in noncarriers, at 3.1% versus 1.3%. Notably, BRCA1 carriers showed a much greater proportion of intermediate unfavourable or high-risk tumours, 56% compared with 18%, despite similar overall incidence rates. Grade upgrading at radical prostatectomy occurred only in carriers. Given that the 2024 European Association of Urology guidelines already support BRCA2 screening, these results suggest BRCA1 carriers should also be considered for systematic screening.

Pathogenic Genomic Alterations in Circulating Tumor DNA Predict Overall Survival in Men with Metastatic Castrate-resistant Prostate Cancer. 
Eur Urol. 2026 Apr;89(4):332-342. doi: 10.1016/j.eururo.2025.07.011. Epub 2025 Aug 6. Halabi S, Guo S, Luo B et al.

 Link to full article:https://pubmed.ncbi.nlm.nih.gov/40774853/

Existing prognostic models for metastatic castration resistant prostate cancer largely ignore genomic alterations detected through circulating tumour DNA, even though such testing is becoming more widely available in clinical practice. To address this gap, researchers analysed data from 776 patients enrolled in a phase 3 trial. Pathogenic alterations in genes including the androgen receptor, MYC, PTEN, TP53 and RB1 were combined with clinical variables to build a clinical genetic model. This model improved prediction of overall survival compared with clinical factors alone, raising the time dependent area under the curve from 0.72 to 0.77, with a net reclassification improvement of 0.29. The model identified three distinct risk groups with median survival times of 19.6, 33.6 and 60.8 months. As PARP inhibitor combinations move into first line treatment, this framework could help refine patient selection for future trials.

Pre-diagnostic circulating untargeted metabolomics and risk of overall and clinically significant prostate cancer: a systematic review and meta-analysis. 
Br J Cancer. 2026 Apr;134(7):1080-1091. doi: 10.1038/s41416-025-03312-x. Epub 2026 Jan 10. Fuller H, Agasaro OP, Guevara JM, Darst BF.

 Link to full article:https://pubmed.ncbi.nlm.nih.gov/41520058/

Although interest in using metabolomics for prostate cancer risk stratification has grown, evidence from individual studies has not previously been pooled and analysed together. This systematic review and meta-analysis combined data from 12 prospective cohorts covering 15,382 men, identifying 33 circulating metabolites significantly associated with prostate cancer risk after correcting for false discovery rate. Of these, 19 were linked to lethal disease, 11 too high or very high-risk cancer, and only 3 to overall disease risk. The associations differed by outcome, with lipids more prominent among high-risk cases and amino acids, nucleotides and peptides more characteristic of lethal disease. Thirteen of the identified metabolites can be influenced through diet or medication. These findings could help guide risk stratified approaches to screening and prevention for clinically significant prostate cancer.