Prostate Cancer Care: Ensuring the Best Next Step for Your Patients

September 12, 2026

by Megan E. Davis

a provider walks down a hallway with a patient

Recent prostate cancer screening and treatment guideline updates include important changes. The 2026 guidance from the American Urological Association (AUA) and its partner societies makes it clearer which patients need further evaluation or treatment — and which can safely avoid or defer it.

Our prostate cancer specialists can help you apply that guidance and match evaluation or treatment to each patient’s specific cancer, health, and priorities.

When to Refer for Prostate Cancer Evaluation

PSA remains elevated on repeat testing, a patient’s overall risk picture raises concern, or you need guidance on whether MRI, biomarkers, or biopsy should come next
After an abnormal digital rectal exam
For risk assessment and treatment planning for a newly diagnosed patient
For high-risk or locally advanced disease, such as Grade Group 4-5, PSA ≥20 ng/mL, or clinical stage T3
Detectable or rising PSA after prostatectomy, or PSA ≥2 ng/mL above the post-radiation nadir
Newly metastatic disease or disease progressing despite systemic therapy
For evaluation for focal therapy, PSMA-targeted treatment, or a clinical trial

From a concerning PSA through advanced disease, our prostate cancer specialists can help determine the right next step and connect your patient with the right care.

Refer a Patient

Evaluating a Persistently Elevated PSA

For a newly elevated PSA, guidelines recommend repeating the test first.

When PSA remains elevated on repeat testing, guidance on when to proceed to biomarkers, imaging, or biopsy remains nuanced. There is no single PSA cutoff that signals further workup is needed. Numerous factors can affect PSA and should be considered.

PSA generally rises with age. Finasteride and dutasteride lower PSA. Black ancestry, a strong family history of prostate cancer, and certain germline mutations increase risk. A rising PSA adds to the risk picture, but PSA velocity alone should not determine whether imaging or biopsy is needed.

We can review these factors and determine whether continued monitoring, prostate MRI, a biomarker test, or biopsy is appropriate for your patient.

When biopsy is needed, we offer MRI-targeted transperineal biopsy. MRI identifies suspicious areas for more precise sampling, while the transperineal approach avoids the rectal wall and reduces infection risk. After a previous negative biopsy, MRI can also help determine whether repeat biopsy is warranted and identify areas to target.

Active Surveillance or Treatment After Diagnosis

The best approach after diagnosis depends on Grade Group, stage, PSA, health, life expectancy, and patient priorities.

Active surveillance is preferred for most low-risk disease.

When treatment is needed, our focal therapy, surgical, and radiation options allow us to tailor treatment to the patient and cancer.

Treatment Options for Localized Prostate Cancer

Focal Therapy

By treating a targeted area rather than the whole prostate, focal therapy may reduce urinary and sexual side effects in carefully selected patients.

We offer two focal therapy approaches: high-intensity focused ultrasound (HIFU) with Focal One and irreversible electroporation (IRE) with NanoKnife.

HIFU is used for localized, targetable intermediate-risk cancers, including Grade Group 2 and 3 disease, and for localized recurrence after radiation.

We offer IRE for localized and targetable intermediate-risk cancers.

Surgery & Radiation

When the cancer’s location allows, nerve-sparing prostatectomy can help preserve erectile function. We also offer Retzius-sparing robotic prostatectomy, which preserves more of the structures supporting the bladder and urethra and can help patients regain continence sooner. Patients begin pelvic floor strengthening before surgery and can receive support for urinary and sexual-function recovery.

Radiation options include external-beam radiation, MRI-guided treatment, and ultrasound-guided high-dose-rate brachytherapy. For higher-risk disease, brachytherapy can be combined with external-beam radiation and hormone therapy. We also use prostate-rectal spacers to limit radiation exposure to nearby tissue.

Rising PSA After Treatment: Early Salvage Evaluation

After prostatectomy, biochemical recurrence is defined as PSA ≥0.2 ng/mL with a confirmatory value above 0.2. When salvage radiation is being considered, guidelines recommend delivering it while PSA is 0.5 ng/mL or lower because outcomes are better at lower PSA levels. Earlier treatment may be considered for patients at high risk of progression.

After radiation, biochemical recurrence is defined as a PSA rise of at least 2 ng/mL above the PSA nadir. PSMA PET can help locate recurrent disease and guide treatment.

PSMA-Targeted Therapy & Clinical Trials for Advanced Disease

For metastatic or treatment-resistant prostate cancer, our specialists can help with treatment selection and sequencing, including androgen receptor pathway therapy, chemotherapy, molecular and genetic testing, PSMA-targeted treatment, and clinical trials.

UVA Health offers Pluvicto, a PSMA-targeted radiopharmaceutical. In July, the FDA expanded its use to certain patients with PSMA-positive metastatic hormone-sensitive prostate cancer.

Our clinical trials include hormone-pathway treatments, bispecific immunotherapies, antibody-drug conjugates, PET-guided treatment intensification, and PSMA-targeted radiopharmaceuticals, including first-in-human research.