Evolving landscape: New Guidelines, PCa screening, and AI collaboration
EAU Guidelines: What's new in early detection?
During the lecture “Introduction EAU Guidelines 2026: What's new in early detection?”, Prof. Johan Stranne (SE) discussed the formal recommendation to repeat PSA (3-10 ng/mL) before further investigations, to reduce unnecessary MRI referrals, decrease biopsy rates, and lower overdiagnosis.
Prof. Stranne also highlighted the strengthened role of clearer MRI-based biopsy decisions. For asymptomatic men with a PSA level between 3 and 20ng/mL, the Guidelines recommended the usage of tools for biopsy indication such as:
- MRI of the prostate
- Risk calculator (provided it is correctly calibrated to the prevalence in the population)
- An additional serum or urine biomarker test
Digital rectal examination (DRE) should not be performed routinely in men without symptoms. When assessing clinical stage, however, it should rely solely on DRE findings, with any additional imaging-based staging information documented separately.
On systematic versus opportunistic PSA testing, the latest Guidelines strongly recommend to not subject men to PSA testing without counselling them on the potential risks and benefits, and offer early PSA testing to well-informed men at elevated risk of having PCa.
PCa screening insights
During her presentation, “Performance of MRI for screening in 2026”, presenter Prof. Caroline Moore (GB) shared that MRI adds value in screened men with a raised PSA. MRI reduces biopsy burden, detects equivalent significant cancer, and reduces detection of indolent cancer. She added, “Systematic biopsy is safe to omit in those with a negative MRI.” She emphasised that identifying the correct MRI threshold will require additional investigation.
In his presentation “MRI in the Real World: Challenges of quality and access”, Prof. Heinz-Peter Schlemmer (DE) stated that quality variability and access disparities regarding MRI in screening programmes can be overcome. “We already have structured training and certification for radiologists in place. We also have quality assurance of technical standards according to the PI-RADS system. In addition, we have image-quality assessment using standardised metrics such as the PI-QUAL system.”
Prof. Schlemmer added that double reading and/or reading supported by AI should be considered. Furthermore, there should be systematic and continuous monitoring of diagnostic performance. “This raises the question should we have certified screening centres?” said Prof. Schlemmer.
Teaming up with AI
“AI can play a pivotal role in all steps of a screening pathway,” said Dr. Maarten De Rooij (NL). In his presentation “AI-assisted MRI, ready for prime-time”, he discussed the advantages of AI usage in the pre-imaging, acquisition, interpretation and report, management stages.
AI can help identify patients qualified for screening during the pre-imaging stage. In acquisition, AI can speed up imaging, improve image quality, and implement screening-specific protocols. AI can segment prostate zones, identify tumour suspicious areas, and automate reports during the interpretation and report stage. It can help reduce the number of false positives to reduce unnecessary biopsies. In addition, AI has improved the ratio GG ≥ 2: GG1; and inter-reader variability. In the management stage, AI can aid in the contouring of prostate lesions and in biopsy and (focal) therapy planning.
Find out about the opposing viewpoints on AI-assisted MRI, the rest of the new EAU Guidelines updates in early detection, and important MRI screening insights by (re)viewing the webcasts of the session via the EAU26 Resource Centre.