N Engl J Med

Study examines role of MRI in prostate cancer screening

September 27, 2024

Among men undergoing PSA screening, omitting biopsy in those with negative MRI results eliminated more than half of diagnoses of clinically insignificant prostate cancer, with very low risk of having incurable cancer diagnosed at screening or as interval cancer.

In this population-based trial, men ages 50 to 60 years with a PSA level of ≥3 ng/mL underwent MRI of the prostate and were randomly assigned to the systematic biopsy group (underwent systematic biopsy and, if suspicious lesions were detected on MRI, targeted biopsy) or the MRI-targeted biopsy group (underwent MRI-targeted biopsy only). Men were invited for repeat screening 2, 4, or 8 years later, depending on PSA level. Primary outcome was detection of clinically insignificant (International Society of Urological Pathology [ISUP] grade 1) prostate cancer. Detection of clinically significant (ISUP grade ≥2) and clinically advanced or high-risk (metastatic or ISUP grade 4 or 5) cancer were also assessed.

After a median follow-up of 3.9 years, the rate of prostate cancer detection was 2.8% in the MRI-targeted biopsy group and 4.5% in the systematic biopsy group. Relative risk of detecting clinically insignificant cancer in the MRI-targeted biopsy group vs. the systematic biopsy group was 0.43 (95% CI, 0.32-0.57; P<0.001) and was lower at repeat rounds of screening relative to the first round (relative risk, 0.25 vs. 0.49); relative risk of a diagnosis of clinically significant prostate cancer was 0.84 (95% CI, 0.66-1.07). The number of advanced/high-risk cancers detected (by screening or as interval cancer) was 15 in the MRI-targeted biopsy group and 23 in the systematic biopsy group (relative risk, 0.65; 95% CI, 0.34-1.24).

Source:

Hugosson J, et al. (2024, September 25). N Engl J Med. Results after Four Years of Screening for Prostate Cancer with PSA and MRI. https://pubmed.ncbi.nlm.nih.gov/39321360/