Prostate cancer screening and treatment continue to evolve as evidence grows and emphasis shifts toward balancing early detection with avoidance of overtreatment. Screening primarily aims to identify clinically significant prostate cancer while minimizing unnecessary biopsies and treatment-related morbidity. Prostate-specific antigen (PSA) testing, combined with digital rectal examination, remains the foundation of screening. Current best practice favors shared decision-making, particularly for men aged 50–69, and earlier for those at higher risk, such as men with a family history or African ancestry. Rather than relying on a single PSA threshold, modern strategies incorporate PSA trends, density, age-adjusted values, and risk calculators to improve specificity.

Advances in imaging have transformed diagnostic pathways. Multiparametric MRI is now commonly used prior to biopsy, allowing better identification of suspicious lesions and enabling targeted biopsies while reducing detection of indolent disease. When cancer is diagnosed, risk stratification based on PSA level, Gleason grade group, tumor stage, and imaging findings guides management decisions.

Treatment options are tailored to disease risk, life expectancy, and patient preferences. Active surveillance is the preferred approach for many men with low-risk prostate cancer, involving regular PSA testing, imaging, and repeat biopsies to monitor for progression while preserving quality of life. For clinically significant disease, curative options include radical prostatectomy and radiation therapy, both of which offer excellent long-term cancer control. Surgical techniques have improved with nerve-sparing approaches and robotic assistance, reducing rates of urinary incontinence and erectile dysfunction. Radiation therapy has also advanced through image-guided, intensity-modulated, and hypofractionated regimens.

For advanced or metastatic disease, systemic therapies play a central role. Androgen deprivation therapy remains the backbone of treatment, with newer androgen receptor–targeted agents, chemotherapy, and radiopharmaceuticals improving survival outcomes. Overall, modern prostate cancer care emphasizes risk-adapted screening, personalized treatment selection, and ongoing surveillance to achieve optimal oncologic control while maintaining quality of life.