MRI Screening Provides Advantages for Detecting Clinically Significant Prostate Cancer

In a recent study published in BMJ Oncology, MRI showed potential benefits in detecting clinically significant prostate cancer (PCa) without using prostate-specific antigen (levels) as its defining criteria.

In the United Kingdom, PCa is the second-leading cause of cancer-related death in men. Among different screening processes, past studies demonstrate the effectiveness of MRI in identifying clinically significant cancers in patients exhibiting higher PSA levels. Researchers reference one study that found methods like standard transrectal biopsies can miss more than half of clinically significant cancers caught by MRIs. The MRI’s detection prowess is clearly useful for reducing unnecessary additional biopsies and rates of overdiagnosis; however, previous research largely hinges on populations with raised PSA levels. Considering this, researchers studied the value of MRI screening independent of PSA and defined their population according to age instead.

Patient databases were accessed in 8 general practices throughout London to identify potential participants. Researchers limited their search to men between 50 to 75 years of age without any prior PCa diagnosis. Eligible individuals were sent a paper invitation to join the study.

A total 2096 invitations were sent and 303 men accepted and were able to undergo screening. Prior to their MRI, PSA blood tests were conducted. The patients’ PSA density would then be calculated using MRI-measured prostate volume. Two radiologists would independently score patient MRIs as positive (PSA density > 0.12 ng/mL) or negative.

Of the 303 screened men, 48 registered positive MRI results (1 in 6, 16%) with a median PSA of 1.2 ng/m. From the pool of individuals with negative MRI results, 16 still showed raised PSA levels and were subsequently referred to the National Health Service for further evaluation. Clinically significant cancer was identified in 25 of the 48 patients (52%) with positive MRI results as well as 4 of the 16 patients (25%) with negative MRIs but raised PSA levels.

The authors mentioned their small sample size only taken from the London area as one of their leading limitations. The COVID-19 pandemic also interrupted their study. They began before the onset of the pandemic and had to pause from April to August 2020 before starting up again. After their restart, many people were hesitant to visit health care facilities and the researchers believe this played a part in poor responses to invitations.

The findings in their report indicate that 2 in 3 men with positive MRI screenings register a PSA < 3 ng/mL and that MRIs can lead to earlier cancer and lesion detection before PSA levels start to rise. For the future of these studies, the researchers call for screenings that include other risk assessments for PCa—such as non-imaging biomarkers—to determine which screening processes are more beneficial throughout the UK population.

Reference

Moore CM, Frangou E, McCartan Neil, et al. Prevalence of MRI lesions in men responding to a GP-led invitation for prostate health check: a prospective cohort study. BMJ Oncology. 2023;2:e000057. doi:10.1136/bmjonc-2023-000057