From the Research
For elevated PSA with BPH and low-risk prostate cancer on MRI, rescreening is typically recommended every 6 months for the first 1-2 years, then annually if stable, as supported by the most recent study 1 which highlights the importance of balancing the need to detect clinically significant cancer progression while avoiding unnecessary treatment of indolent disease.
Rescreening Approach
The approach to rescreening should include:
- PSA testing
- Digital rectal examination, although its value is debated in the context of modern MRI-based diagnostic pathways 2
- Repeat MRI imaging every 1-2 years to monitor any changes in the identified lesion
Active Surveillance
Active surveillance is often appropriate for low-risk prostate cancer, avoiding immediate treatment while carefully monitoring for progression. The frequency of follow-up may be adjusted based on:
- PSA velocity (how quickly levels rise)
- Age
- Overall health status
- Family history
Adjusting Follow-Up
If PSA rises significantly (typically more than 0.75 ng/mL per year), shows a consistent upward trend, or if follow-up MRI shows progression, the doctor may recommend additional testing such as a prostate biopsy. This monitoring approach is supported by studies that emphasize the importance of early detection and intervention for clinically significant prostate cancer 1, 3.
Evidence Summary
The most recent and highest quality study 1 provides evidence for the effectiveness of MRI-targeted biopsy in reducing the risk of overdiagnosis of prostate cancer, while other studies 3, 2 highlight the limited value of digital rectal examination in the modern MRI-based diagnostic pathway. Overall, the approach to rescreening and active surveillance should prioritize the detection of clinically significant cancer progression while minimizing unnecessary treatment and interventions.