Früherkennung des Prostatakarzinoms – Empfehlungen der aktualisierten S3-Leitlinie 2025

Background: The 2025 update of the German S3 guideline on prostate cancer introduces major revisions in early detection and diagnostic strategies, marking a paradigm shift in the management of localized prostate cancer. Methods: This review summarizes the main evidence-based recommendations on early detection derived from the systematic evidence synthesis conducted for the 2025 guideline update. Results: The revised guideline establishes a risk-adapted, prostate-specific antigen (PSA)-based screening strategy starting at age 45, with individualized follow-up intervals (2 or 5 years) and indication-based diagnostic clarification using short-term PSA retesting, multiparametric magnetic resonance imaging (mpMRI), and targeted biopsy where appropriate. Digital rectal examination is no longer recommended for screening purposes. The structured integration of mpMRI increases the detection of clinically significant prostate cancer while reducing unnecessary biopsies and overdiagnosis. Active surveillance (AS) is a key component of the updated early detection and management strategy. For men with low-risk disease (ISUP 1), the guideline issues a strong “should” recommendation for AS, whereas for men with favorable intermediate-risk disease (ISUP 2 without cribriform or intraductal growth and with a limited proportion of Gleason pattern 4), AS carries a weaker “may” recommendation. Recent 15-year long-term results from the international Prostate Cancer Research International: Active Surveillance (PRIAS) cohort confirm the oncological safety of AS and highlight the pivotal role of mpMRI in patient selection and longitudinal monitoring. Conclusion: Combining individualized PSA-based early detection with high-quality MRI diagnostics enables precise, risk-adapted, and patient-centered prostate cancer management. This approach minimizes overdiagnosis and overtreatment while ensuring timely intervention for clinically relevant disease.