Purpose <p>Traditionally, serum prostate-specific antigen (PSA) has been the cornerstone of prostate cancer screening owing to its wide availability, feasibility, and cost-effectiveness. However, PSA centred screening is limited by poor specificity, resulting in overdiagnosis of clinically insignificant disease, and, conversely, underdiagnosis of clinically significant cancers. The role of digital rectal examination in contemporary screening is being questioned due to its limited sensitivity and interobserver variability.</p> Methods <p>We conducted a structured narrative review of the literature on current trends in prostate cancer screening, recent updates and prospects through major databases.</p> Results <p>Recent advances in Multiparametric Magnetic Resonance Imaging (mpMRI), novel serum and urine biomarkers, liquid biopsy, genetic risk scores, and nomograms are shifting the paradigm towards precision-based prostate cancer screening. MRI-first and biomarker-enhanced strategies have demonstrated improved detection of clinically significant prostate cancer (CSPC) while reducing unnecessary biopsies and related morbidity. Risk-adapted screening models that integrate PSA levels, clinical risk factors, biomarkers, and selective use of mpMRI offer a pragmatic balance between diagnostic accuracy and feasibility, particularly in resource-limited healthcare settings.</p> Conclusion <p>Prostate cancer screening is shifting toward risk-adapted strategies that combine PSA with selective biomarkers and mpMRI to improve detection of clinically significant disease and reduce unnecessary interventions. However, robust prospective validation and context-specific cost-effectiveness data are required before widespread implementation, particularly in resource-limited settings.</p>