Socioeconomic status (SES) and other social determinants of health are also significant sources of disparity in prostate cancer diagnosis and treatment. While prostate cancer diagnosis rates are positively associated with socioeconomic status, lower SES tends to correlate with worse outcomes. Men with lower SES tend to be diagnosed at later stages of the disease, are more likely to have metastases at the time of diagnosis, and have decreased survival rates. Overcoming these disparities requires a multifaceted approach that includes increasing awareness and education about prostate cancer risk, addressing social determinants of health, and, perhaps most critically, making screening and treatment more accessible and affordable for all patients. 

Early cancer detection requires effective, accessible, and actionable screening approaches. The prostate-specific antigen (PSA) test is the current standard for prostate cancer screening. Elevated levels of PSA in the blood are indicative of prostate disease, warranting follow-up testing, such as a biopsy, to establish a cancer diagnosis. However, the PSA test is not a perfect cancer screening tool. Because an elevated PSA result can be caused by non-cancerous conditions, such as an enlarged prostate, prostatitis, or even riding a bicycle, high PSA can essentially be a false positive that results in further unnecessary testing. Men with an elevated PSA level have a roughly 1 in 4 chance of having prostate cancer, but not all cases constitute high-grade disease that warrants intervention. 

The limitations of PSA testing are further exacerbated by the discomfort and risk associated with prostate biopsy. In addition to being stressful and unpleasant for most patients, the procedure can result in infection and even life-threatening sepsis. When screening methods fail to yield clear results and leave patients to face unnecessary follow-up testing, there is little incentive to actively pursue screening. This only widens the disparities in timely prostate cancer diagnosis associated with distrust, embarrassment, financial strain, and limited access to healthcare. 

Mitigating prostate cancer disparities through earlier detection will require affordable and accurate testing that provides specific, actionable results and is easy to implement in virtually any community healthcare setting. Novel diagnostic technologies have largely shifted to a focus on biomarkers at the level of the genome or transcriptome, but the data gleaned from these approaches represents molecular instructions that may not directly translate into protein- or disease-relevant alterations. While their insights can be valuable for guiding the selection of molecularly targeted therapies, the relatively high cost and complex interpretation of RNA- and DNA-focused diagnostics limits their applicability as screening tools. 

Alternatively, by turning to simpler, more cost-effective methods that emphasise efficiency and accuracy, we can create screening tools that overcome the limitations of PSA testing while broadening patient access. Innovative approaches, such as tools that assess alterations in PSA structure, rather than concentration, can help identify patients at greatest risk for prostate cancer without requiring specialised equipment or advanced interpretation. More specific insights can, in turn, reduce the number of unnecessary biopsies and mitigate the stress and costs associated with excessive diagnostic procedures.