Background Prostate-specific antigen (PSA) testing, long used for prostate cancer screening, is limited by poor specificity (~25%), leading to unnecessary biopsies in over 70% of cases and substantial healthcare costs. Methods This review synthesizes recent evidence (2023–2025) on emerging non-invasive diagnostics—saliva-based polygenic risk scores (PRS) and artificial intelligence (AI) -enhanced imaging—as potential alternatives to PSA. Results Saliva-derived PRS, incorporating over 130 genetic variants, have demonstrated superior risk stratification. In the BARCODE1 trial, 40% of men with high PRS proceeded to targeted MRI and biopsy, detecting aggressive cancer in 55. 1% of cases—outperforming PSA-based detection. Concurrently, AI-assisted multiparametric MRI (mpMRI) has shown diagnostic accuracies up to 92% for clinically significant tumors (Gleason ≥7), while reducing radiologist workload by approximately 50%. Combining PRS and AI, as explored in multi-modal strategies (e. g. , PATHFINDER trial), has yielded sensitivity rates up to 95% and demonstrated cost-effectiveness, with projected savings of ~50, 000 per quality-adjusted life year. Conclusion However, disparities persist: PRS performance varies by ancestry, and AI models trained on homogeneous datasets show reduced accuracy in underrepresented populations, as highlighted in the TRANSFORM trial.
Li et al. (2025) studied this question.