4Kscore as reflex test could cut MRI referrals 71% in men with PSA 1.8-2.99
Prospective · Eur Urol Open Sci · 2026-10-31. Number 4 in the UrologyWatch Top 5 for October 31, 2026.
Among 555 men from the Göteborg-2 screening trial with PSA 1.80-2.99 ng/ml, a 4Kscore cutoff of 7.5% detected 56% of ISUP grade 2+ cancers with 56% sensitivity and 72% specificity, and would have reduced MRI referrals by 71% and biopsies by 67% versus imaging all men in this PSA range.
Why it matters: Suggests 4Kscore could help triage men with borderline-low PSA before MRI, though the approach would miss 44% of clinically significant cancers in this range.
Limitation: Single nested biomarker study within one screening trial; modest sensitivity (56%) means a substantial fraction of significant cancers would be missed under this strategy.
Source: Eur Urol Open Sci · PubMed 42960148 · DOI 10.1016/j.euros.2026.10.001
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