Integration of MRI screening beneficial for prostate cancer

Integrating magnetic resonance imaging (MRI) into prostate cancer (PCa) screening is associated with a reduction in unnecessary biopsies and overdiagnosis of insignificant disease, according to a review published online April 5 in JAMA Oncology to coincide with the 39th Annual European Association of Urology Congress, held from April 5 to 8 in Paris.

Tamás Fazekas, M.D., from the Medical University of Vienna, and colleagues conducted a systematic review to compare the diagnostic value of screening pathways incorporating MRI with targeted biopsy and prostate-specific antigen (PSA)-based screening with systematic biopsy strategies.

Data were included from 12 studies with 80,114 men. The researchers found that the MRI pathway was associated with higher odds of clinically significant (cs) PCa compared with standard PSA-based screening when test results were positive (odds ratio, 4.15). Reduced odds of biopsy and detection of insignificant cancers were observed (odds ratios, 0.28 and 0.34, respectively), with no significant differences seen in csPCa detection between the MRI-only and PSA-only screening methods.

A further reduction in the odds of detecting insignificant PCa and biopsies performed was seen with implementation of a threshold of a Prostate Imaging Reporting and Data System score of 4 or greater for biopsy selection (odds ratios, 0.23 and 0.19, respectively); no differences were seen in csPCa detection.

"We found that MRI mitigates pitfalls of standard PSA-based strategies, as it can be associated with fewer unnecessary biopsies and helps to avoid the detection of insignificant cancers while not comprising significant disease detection," the authors write.

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